頭頸部地区における経口的ロボット手術：単一施設で治療を受けた67例の患者を対象としたレトロスペクティブ研究

Transoral robotic surgery in head and neck district: a retrospective study on 67 patients treated in a single center.

• Fraco Ionna
• Agostino Guida
• Luigi Califano
• Gaetano Motta
• Giovanni Salzano
• Ettore Pavone
• Corrado Aversa
• Francesco Longo
• Salvatore Villano
• Ludovica Marcella Ponzo
• Pierluigi Franco
• Simona Losito
• Franco Maria Buonaguro
• Maria Lina Tornesello
• Maria Grazia Maglione

抄録

背景:

口咽頭の解剖学的な複雑さとその遠位部に到達することの難しさは、常に手術へのアクセス性を条件としてきました。

Background: The anatomical complexity of the oropharynx and the difficulty in reaching its distal portion have always conditioned the surgical accessibility.Robotic surgery represents an excellent alternative in the treatment of cervico-facial oncological diseases.

方法:

このシリーズはTrans Oral Robotic Surgery TORSで頭頸部癌の治療を受けた全患者で構成されています。すべてのカルテには、氏名・苗字、年齢、性別、手術日、術中または術後の出血、腫瘍部位、組織学、TNM病期、ロボットセットアップ時間、腫瘍切除時間、気管切開の有無、頸部郭清の有無、経鼻胃管または胃瘻の挿入、経口栄養再開までの時間、手術断端、平均在院日数、アジュバント治療、フォローアップのデータを記録した。

Methods: This series comprises all patients managed for head and neck cancer by Trans Oral Robotic Surgery TORS.The staging assessment, including neck ultrasound and total body PET/CT scan, was performed in each patient according to the TNM classification.All charts were recorded with the following data: name and surname, age, gender, date of surgery intra or post-operative hemorragia, tumor site, histology, TNM stage, robot set-up time, tumor resection time, whether or not tracheotomy was performed, whether or not neck dissection was performed, insertion of a nasogastric tube or gastrostomy, time to resumption of oral feeding, surgical margins, mean length of hospital stay, adjuvant treatment and follow-up.

結果:

2013年2月から2018年2月まで、頭頸部腫瘍に罹患した67名の連続した患者を対象にTORSを実施した。病理検査では44例に悪性腫瘍が認められ、リンパ腫8例、扁平上皮癌36例、唾液腺良性腫瘍5例、その他18例であった。呼吸不全に対して気管切開を行ったのは3/67例であった。手術の最後に経鼻胃管を挿入したのは21例であった。主な合併症は術後出血3例、術後20日で大量出血1例、気管切開と集中治療室（ICU）での3日間のモニタリングを行った呼吸不全1例であった。

Results: From February 2013 to February 2018, TORS was performed in 67 consecutive patients affected by head and neck tumours.We divided, our sample, in 3 subsites: supraglottic larynx, parapharyngeal space and oropharynx.Pathology reports confimed malignancy in 44 cases: 8 cases lymphomas, 36 cases of Squamous cell carcinoma (SCC), 5 cases of benign salivary glands tumors and 18 miscellaneous cases. Neck dissection was performed in 12 cases.Tracheotomy was perfomed in 3/67 cases for respiratory failures. A nasogastric tube was inserted at the end of the surgical procedure in 21 patients. The mean length of hospital stay was 10 days .Major complications included post-operative bleeding in 3 patients, 1 exitus for massive bleeding 20 days post-surgery and 1 respiratory failure treated with tracheotomy and monitoring in the Intensive Care Unit (ICU) for 3 days.

結論:

ロボット手術は、多くの専門分野において、従来の開腹治療に代わる有効な手段と考えられており、内視鏡手術と同様の腫瘍学的・機能的な結果が得られ、合併症も少ないという利点があります。このタイプの外科技術の利点が議論されている、それは適応と禁忌に焦点を当てることが必須です。

Conclusions: Robotic surgery has been considered a valid alternative to traditional open treatment in many specializations with the advantages of an endoscopic procedure, with the same oncological and functional results and with fewer complications. The advantages of this type of surgical technique have been discussed, it is mandatory to focus on the indications and contraindications.

© The Author(s) 2020.