经口机器人手术在cT1-T3喉返神经癌中的外科、功能及肿瘤学疗效：系统综述
Surgical, Functional, and oncological outcomes of transoral robotic surgery for cT1-T3 supraglottic laryngeal Cancers: A systematic review
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影响因子:3.9
分区:医学2区 / 牙科与口腔外科2区 肿瘤学3区
发表日期:2024 Dec
作者:
Jérôme R Lechien
DOI:
10.1016/j.oraloncology.2024.107047
摘要
本系统综述调查了经口机器人喉上盖切除术（TORS-SGL）在cT1-T3喉鳞状细胞癌（LSCC）中的外科、功能和肿瘤学疗效。两位研究人员依据PRISMA声明，对PubMed、Scopus和Cochrane Library数据库中关于TORS-SGL的外科、功能及肿瘤学结局的研究进行了最新的系统评价。偏倚分析采用MINORS工具进行。共纳入21项研究，涉及896名患者。TORS-SGL主要用于cT1（39.1%）、cT2（46.9%）及部分选择性cT3（7.7%）LSCC病例。手术切缘阳性率为10.8%。平均住院天数为8.6天。出血（6.3%）、肺炎（5.5%）及误吸（1.7%）为主要并发症。手术切缘阳性率为10.6%。喂食管、暂时性气管切开术和永久性经皮胃造口术的发生率分别为65.6%、19.7%及5.2%。口服饮食在平均7.2天后恢复。TORS-SGL的5年总生存率（OS）和无疾病生存率（DFS）估计分别为78.3%和91.7%，5年局部复发无病生存率和颈部淋巴结复发无病生存率分别为90.8%和86.6%。综上所述，TORS-SGL是一种安全且有效的cT1-T3喉上盖切除手术方式，其功能和外科效果与TOLM-SGL相当。其肿瘤学疗效可能优于TOLM和开放式喉上盖切除术，但仍需更多大规模队列对照研究以得出可靠结论。
Abstract
This systematic review investigated the surgical, functional, and oncological outcomes of transoral robotic supraglottic laryngectomy (TORS-SGL) for cT1-T3 laryngeal squamous cell carcinoma (LSCC).Two investigators conducted an updated PubMed, Scopus, and Cochrane Library systematic review for studies investigating the surgical, functional, and oncological outcomes of TORS-SGL using the PRISMA statements. The bias analysis was conducted with the MINORS.Twenty-one studies were included, accounting for 896 patients. TORS-SGL was primarily performed for cT1 (39.1 %), cT2 (46.9 %), and some selected cT3 (7.7 %) LSCCs. Surgical margins were positive in 10.8 % of cases. The mean hospital stay was 8.6 days. Hemorrhage (6.3 %), pneumonia (5.5 %), and aspiration (1.7 %) are the primary complications. The surgical margins were positive in 10.6 % of cases. Feeding tubes, temporary tracheotomy, and definitive percutaneous gastrostomy are found in 65.6 %, 19.7 %, and 5.2 % of patients, respectively. The oral diet is restarted after a mean of 7.2 days. The 5-year OS and DFS of TORS-SGL were estimated to be 78.3 %, and 91.7 %, with 5-year local-relapse-free survival and nodal-relapse-free survival of 90.8 %, and 86.6 %, respectively.The TORS-SGL is a safe, and effective surgical approach for cT1-T3 SGL. The functional and surgical outcomes appear comparable with TOLM-SGL. The oncological outcomes of TORS-SGL could be better than TOLM and open SGLs, but further large cohort-controlled studies are needed to draw reliable conclusions.