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By Catherine H. Frenkel, MD

The prevalence of HPV-related head and neck cancer has increased dramatically over the last decade. In fact, these cancers have overtaken cervical cancer as the most common HPV-related malignancy in the United States. Treatment has traditionally been limited to complex surgery and/or aggressive chemotherapy and radiation – but a minimally invasive technique called Transoral Robotic Surgery (TORS) is changing the game.

TORS improves surgeons’ accuracy, shortens recovery time and can eliminate the need for chemotherapy and/or radiation – all while dramatically reducing the risk of swallowing problems and other long-term complications.

Drawbacks of Traditional Treatments

Historically, aggressive chemotherapy and radiation have been the first-line treatment for oropharynx tumors and other head and neck cancers. But the complications – dysfunctional swallowing, dysphagia, aspiration pneumonia, feeding tubes and osteoradionecrosis (a disease that destroys blood flow to the jaw bone, leading to chronic pain, infections and exposed bone in the mouth) – can be severe and long-lasting.

In addition, some patients underwent the “commando procedure,” a full day of surgery that required splitting the mandible and making an incision from lip to throat. Hospital stays ranged from 7 to 15 days, and patients often needed swallowing and speech rehabilitation.

How TORS Works

TORS removes the need for a large incision by letting surgeons access tumors through the mouth. Using a leading-edge robotic surgical system, the surgeon is guided by a 3D camera and uses instruments with technology that can turn a full 360 degrees and eliminate tremor to resect the tumor. These instruments are more precise and dexterous than the human hand.

The procedure generally takes about 90 minutes, and patients typically go home within 3 days or less. The minimally invasive technique means less scarring, shorter recovery times and a quicker return to preoperative speech and swallowing abilities.

Minimizing Chemotherapy and Radiation

For some patients, TORS can successfully remove all cancerous tissues – eliminating the need for chemotherapy and radiation. If patients do still require radiation, a lower dose of therapy is necessary to successfully complete treatment.

At Levine Cancer Institute (LCI), we’ve seen this make a huge difference for HPV-related cancer patients, who tend to be younger and otherwise healthy. They can return to work and normal activities faster, and are far less likely to have speech and swallowing dysfunction and other treatment-related side effects.

LCI’s Multidisciplinary Approach

Patients travel from across the region to undergo TORS at LCI, drawn by our expertise and our multidisciplinary approach.

Our surgeons work hand-in-hand with LCI’s renowned radiation and medical oncologists. This ensures that post-surgical treatment incorporates the latest approaches for keeping radiation and chemotherapy to a minimum.

We also team up with in-house speech and language pathologists, as well as nutritionists, to help patients overcome eating and speech issues that can go along with head and neck surgery. This enables us to treat patients from every angle and give them the best chance at success.

To learn more or refer a patient, call Levine Cancer Institute at 980-442-3320