Transoral Robotic Surgery

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What to do hypopharyngeal cancer patients and upper airway obstructive patients who do not comply with CPAP have in common?
These diseases are both deadly and both lead to significant upper airway obstruction. In the past, treatment ranged from radical surgery to radical chemotherapy-radiotherapy protocols for head and neck cancer treatment. Options for sleep apnea ranged from radical maxilla-mandibular advancement procedures to tracheotomy.

Since the Food and Drug Administration’s (FDA) approval of transoral robotic surgery (TORS) for the treatment of T1 and T2 oropharyngeal cancer in 2009, it has gained broad acceptance as an effective method of treating selected head and neck tumors. Concomitant with this, there has been a rise in the incidence of Human papilloma virus (HPV)-associated oropharyngeal cancer, which often presents with an early T-stage primary tumor. This has created an opportunity for widespread use of this novel technique.

Approach to upper airway obstruction has also progressed to sleep endoscopy methods to study physiological site of obstruction, use of lingual tonsillectomy for those with GERD induced lingual tonsil hypertrophy, and use of TORS for base of tongue / epiglottic procedures to relieve site of obstruction in sleep apnea patients who do not tolerate or comply with use of CPAP.

Review of National Inpatient Survey (NIS) data at a population-level investigation of national us-age patterns of TORS for HNC in the United States has shown:

1. The use of TORS for HNC has increased dramatically without significant changes in median length of stay or median hospital charges.
2. Racial, socioeconomic, and regional disparities exist in the use of TORS for HNC pa-tients.
3. Though variations in HPV prevalence and tumor stage likely contribute to these dispari-ties, further investigation is needed into the availability of TORS to minorities and low-income individuals.
Work-up may include physical examination, endoscopy in office and operating room, chest radi-ography, upper respiratory tract radiology, update of sleep studies, counseling with respective associated fields (medical oncology, radiation oncology, dietician, social worker, sleep medicine physician, medical weight loss physician, etc), baseline spirometry, bronchoscopy, EKG, pH probe studies, esophagoscpy, and other patient specific evaluations.

The management of head and neck cancer and sleep apnea in adults can be complex. I do pro-vide service in these areas and would be happy to evaluate your patients.

If you have any questions regarding chronic cough or other area of ear, nose, throat, head and neck cancer, sleep surgery, thyroid and parathyroid, please do not hesitate to call. ENT is trained in 7 core areas over a 5 year residency after medical school: allergy, facial plastic and reconstructive surgery, head and neck, laryngology, otology, pediatric otolaryngology, and rhinology. We are the only surgical specialty dedicated solely to this area.

Philip Harris, M.D. FACS
MidMichigan Physicians Group
Midland / Gladwin / Bay City
Phone (989) 839-6201
www.midmichigan.org/mpg

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