New technology for transoral robotic surgery
Providence Portland Medical Center is one of only a few hospitals in the United States with the DaVinci SP (single port) robot. Our head and neck surgeons are using this new technology to personalize treatment, lessen radiation or chemotherapy and protect taste and swallowing in cancer patients.
“The flexible arms and high-resolution camera on the new SP robot will allow for expanded indications to safely remove cancers from the back of the throat in a minimally invasive manner that optimizes functional outcomes.” says Dr. Bryan Bell, Medical Director of the Providence Head and Neck Cancer Program.
In 2011 Dr. Bell was one of the first surgeons in the world to begin using transoral robotic surgery (TORS) to treat head and neck cancer. Dr. Ashish Patel, also an accomplished robotic surgeon, has since joined the Providence Cancer Institute as a member of the head and neck surgical team. TORS is minimally invasive and offers personalized treatment for each patient. For many patients, the use of TORS eliminates the need for radiation or chemotherapy. Even if radiation is recommended after TORS, the dose is usually much less, which protects the patient’s ability to taste and swallow.
Recently, members of the Providence Head and Neck Cancer Program published a paper in the Oral Oncology Journal, on their experience with TORS and “risk adapted adjuvant therapy”.
Important findings included:
- A 91%, 5-year survival rate for patients with human papilloma virus (HPV) related oropharynx cancer
- Since 2015, more than 80% of patients did not need chemotherapy
Many of the patients in the Providence study were also treated on a National Institutes of Health funded clinical trial, ECOG 3311. This was a randomized trial of de-escalated radiation following TORS for intermediate risk HPV positive oropharyngeal cancer. The results of this trial were recently presented at the ASCO 2020 Virtual Scientific Program. With similar oncologic outcomes as in the Providence series, for those patients with uninvolved surgical margins, <5 involved lymph nodes, and minimal (<1mm) extranodal extension, reduced dose postoperative radiation without chemotherapy appears sufficient.
Providence researchers have recently opened a clinical trial of adjuvant de-escalated radiation + immunotherapy with nivolumab to improve functional and oncologic outcomes. Nivolumab boosts the immune system response in patients with cancer and has been shown to improve survival for patients with head and neck cancer. This trial, open at only a few sites in the world, provides a new approach for the body’s own immune system to eliminate cancer cells after surgery and low-dose radiation.
For more information about Providence Cancer Institute’s Head and Neck Cancer Program click here.
Image provided by Intuitive Surgical, 2020
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