Cirugía Robótica Transoral (TORS), en el manejo de lesiones neoplásicas de cabeza y cuello

  • Enrique Cadena Instituto Nacional de Cancerología
  • Ricardo Guerra Clínica de Marly
  • Carlos Pérez Mitchell Instituto Oncológico de Cabeza y Cuello Hospital HIMA San Pablo
Palabras clave: Carcinoma de células escamosas, Neoplasias de cabeza y cuello, Robótica, Operaciones remotas

Resumen

El cáncer de cabeza y cuello es una enfermedad muy complicada cuya incidencia ha venido incrementando en la última década y está relacionada con la infección del virus del papiloma humano. La base del tratamiento es la cirugía, que debe hacerse con intervenciones extensas y mutilantes a través del cuello, son acompañadas de quimioterapia y radioterapia, dejando secuelas funcionales difíciles de manejar. Desde 2009 se aprobó el uso del robot Da Vinci® para resecar tumores de la orofaringe y supraglotis, con la cirugía robótica transoral. Las bondades de esta técnica, que inciden en la pronta recuperación del paciente, y que están derivadas de la excelente visión tridimensional y la versatilidad de movimientos del instrumental articulado (EndoWrist®), han hecho que las recomendaciones de su uso estén redefiniéndose continuamente. Este artículo resume las ventajas, las desventajas, las indicaciones de manejo actual, el cuidado posoperatorio, la rehabilitación y la terapia adyuvante de este novedoso tratamiento.

Biografía del autor/a

Enrique Cadena, Instituto Nacional de Cancerología

Grupo Cirugía de Cabeza y Cuello, Instituto Nacional de Cancerología, Bogotá D.C., Colombia
Unidad de Otorrinolaringología, cirugía de cabeza y cuello, cirugía robótica, Cirurobótica, Clínica de Marly, Bogotá D.C., Colombia
Unidad Otorrinolaringología, Universidad Nacional

Ricardo Guerra, Clínica de Marly

Unidad de Otorrinolaringología, cirugía de cabeza y cuello, cirugía robótica, Cirurobótica, Clínica de Marly, Bogotá D.C., Colombia
Unidad de Otorrinolaringología, Sesión de Laringología, Hospital Universitario Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá D.C., Colombia

Carlos Pérez Mitchell, Instituto Oncológico de Cabeza y Cuello Hospital HIMA San Pablo

Instituto Oncológico de Cabeza y Cuello Hospital HIMA San Pablo, Caguas, Puerto Rico
Departamento de Otorrinolaringología, Cirugía de Cabeza y Cuello, Universidad de Puerto Rico Recinto de Ciencias Médicas, San Juan, Puerto Rico

Referencias

InstitutoNacional de Cancerología (INC). Anuario estadístico 2010. Bogotá: INC; 2012.

Weinstein GS, O'Malley Jr BW, Hockstein NG. Transoral robotic surgery: supraglotic laryngectomy in a canine model. Laryngos- cope. 2005;115:1315-9.

https://doi.org/10.1097/01.MLG.0000170848.76045.47

O'Malley Jr BW, Weinstein GS, Snyder E, Hockstein NG. Transoral Robotic surgery (TORS) for base of tongue neoplasms. Laryngoscope. 2006;116:1465-76.

https://doi.org/10.1097/01.mlg.0000227184.90514.1a

Quon H, O'Malley Jr BW, Weinstein GS. Transoral robotic surgery (TORS) for the head and neck: current and future indications. International journal head neck surg. 2010;1(3):133-40.

https://doi.org/10.5005/jp-journals-10001-1027

Park YM, Kim WS, Byeon HK, De Virgilio A, Lee SY, Kim S-H. Clinical Outcomes of transoral robotic surgery for head and neck tumors. Ann Surg Rhinol Laryngol. 2013;122(2):73-84.

https://doi.org/10.1177/000348941312200202

Laccourreye O, Hans S, Menard M, Garcia D, Brasnu D, Holsinger FC. Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: II. An analysis of the incidence, related variables, and consenquences of local recurrence Arch otol head neck surg. 2005;131(7):592-9.

https://doi.org/10.1001/archotol.131.7.592

Weinstein GS, O'Malley Jr BW, Snyder W, Sherman E, Quon H. Transoral Robotic Surgery: Radical tonsillectomy. Arch otol head neck surg. 2007;133(12):1220-6.

https://doi.org/10.1001/archotol.133.12.1220

Rinaldi V, Pagani D, Toretta S, Pignataro L. Transoral robotic surgery in the management of the head and neck tumors. Ecancer. 2013. DOI: 10.3332/ecancer. 2013.359.

https://doi.org/10.3332/ecancer

Aubry K, Yachine M, Lerat J, Vivent M, Perez AF, Scomparin A. Transoral robotic surgery for the treatment of head and neck cancer of various localizations. Surgical innovation. 2012;19(1):60-6.

https://doi.org/10.1177/1553350611413612

Genden EM, Desai S, Sung C-K. Robotic surgery for the management of head and neck cancer: A preliminary experience. Head neck. 2009. DOI: 10.1002/hed. 20972: 283-289.

https://doi.org/10.1002/hed.20972

Moore EJ, Olsen SM, Laborde RR, García JJ, Walsh FJ, Price DL, et al. Long-term functional and oncologic results of transoral robotic surgery for oropharyngeal squamous cell carcinoma. Mayo Clinic proceedings. 2012;8(3):219-25.

https://doi.org/10.1016/j.mayocp.2011.10.007

Weinstein GS, Quon H, Newman J, Chalian JA, Malloy K, Lin A, Desai A, et al. Transoral robotic surgery alone for oropharyngeal cancer. Arch Otolaryngol Head Neck Surg. 2012;138(7): 628-34.

https://doi.org/10.1001/archoto.2012.1166

Abuzeid WM, Bradford CR, Divi V. Transoral robotic biopsy of the tongue base: a novel paradigm in the evaluation of unknown primary tumors of the head and neck. Head Neck. 2013;35(4):126-30.

https://doi.org/10.1002/hed.21968

Mehta V, Johnson P, Tassler A, et al. A new paradigm for the diagnosis and management of unknown primary tumors of the head and neck: a role for transoral robotic surgery. Laryngoscope 2013. 2012;123(1):146-51.

https://doi.org/10.1002/lary.23562

de Almeida JR, Park RC, Genden EM. Reconstruction of transoral robotic surgery defects: principles and techniques. J Reconstr Microsurg. 2012;28(7):465-72.

https://doi.org/10.1055/s-0032-1313762

O'Connell DA, Rieger J, Harris JR, Dziegielewski P, Zalmanowitz J, Sylasanko A, et al. Swallowing function in patients with base of tongue cancers treated with primary surgery and reconstructed with a modified radial forearm flap. Arch Otolaryngol Head Neck Surg. 2008;134(8):857-64.

https://doi.org/10.1001/archotol.134.8.857

Genden EM, Park R, Smith C, Kotz T. The role of reconstruction for transoral robotic pharyngectomy and concomitant neck dissection. Arch Otolaryngol Head Neck Surg. 2011;137(2):151-6.

https://doi.org/10.1001/archoto.2010.250

Seikaly H, Rieger J, Zalmanowitz J, Tang JL, Alkahtani K, Ansari K, et al. Functional soft palate reconstruction: a comprehensive surgical approach. Head Neck. 2008;30(12):1615-23.

https://doi.org/10.1002/hed.20919

Weinstein GS, OM ́alley Jr WB, Snyder W, Hockstein NG. Transoral robotic surgery: supraglottic partial laryngectomy. Ann Otol Rhinol Laryngol. 2007;116(1):19-23.

https://doi.org/10.1177/000348940711600104

Dziegielewski PT, Ozer E. Transoral robotic surgery: supraglotic laryngectomy. Operative techniques otolaryngology. 2013;24(2):86-91.

https://doi.org/10.1016/j.otot.2013.04.003

Park YM, Kim WS, Byeon HK, De Virgilio A, Jung JS, Kim S-H. Feasibility of transoral robotic hypopharyngectomy for early-stage hypopharyngeal carcinoma. Oral oncology. 2010;46:597-602.

https://doi.org/10.1016/j.oraloncology.2010.05.003

Cadena E, Angarita E, Estévez JA, Buitrago G. PET-TC en pacientes con tumores de cabeza y cuello. Rev Colomb Cancerol. 2011;15 Supl.1:45-55.

https://doi.org/10.1016/S0123-9015(13)70039-8

Madani I, Vakaet L, Bonte K, Boterberg T, De Neve W. Intensitymodulated radiotherapy for cervical lymph node metastases from unknown primary cancer. Int J Radiat Oncol Biol Phys. 2008;71:1158-66.

https://doi.org/10.1016/j.ijrobp.2007.11.059

Haas I, Hoffmann TK, Engers R, Ganzer U. Diagnostic strategies in cervical carcinoma of an unknown primary (CUP). Eur Arch Otorhinolaryngol. 2002;259:325-33.

https://doi.org/10.1007/s00405-002-0470-1

Grau C, Johansen LV, Jakobsen J, Geertsen P, Andersen E, Jensen BB. Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol. 2000;55:121-9.

https://doi.org/10.1016/S0167-8140(00)00172-9

Fischer CA, Kampmann M, Zlobec I, et al. p16 expression in oropharyngeal cancer: its impact on staging and prognosis compared with theconventional clinical staging parameters. Ann Oncol. 2010;21:1961-6.

https://doi.org/10.1093/annonc/mdq210

Begum S, Gillison ML, Nicol TL, Westra WH. Detection of human papillomavirus-16 in fine-needle aspirates to determine tumor origin in patients with metastatic squamous cell carcinoma of the head and neck. Clin Cancer Res. 2007;13:1186-91.

https://doi.org/10.1158/1078-0432.CCR-06-1690

Lee JM, Weinstein GS, O'Malley Jr BW, Thaler ER. Transoral robot-assisted lingual tonsillectomy and uvulopalatopharyngoplasty for obstructive sleep apnea. Ann Otol Rhinol Laryngol. 2012;121:635-9.

https://doi.org/10.1177/000348941212101002

Friedman M, Hamilton C, Samuelson CG, Kelley K, Taylor D, Pearson-Chauhan K, Maley A, Taylor R, Venkatesan TK. Transoral robotic glossectomy for the treatment of obstructive sleep apnea-hypopnea syndrome. Otolaryngol Head Neck Surg. 2012;146:854-62.

https://doi.org/10.1177/0194599811434262

Vicini C, Dallan I, Canzi P, Frassineti S, Nacci A, Seccia V, et al. Transoral robotic surgery of the tongue base in obstructive sleep Apnea-Hypopnea syndrome: anatomic considerations and clinical experience. Head Neck. 2012;34:15-22.

https://doi.org/10.1002/hed.21691

Cadena E, Sanabria A. Disección ganglionar de cuello conceptos actuales. Rev Colomb Cancerol. 2011;15(3):31-40.

Shoaib T, Soutar DS, Macdonald DG, Gray HW, Ross GL. The nodal neck level of sentinel lymph nodes in mucosal head and neck cancer. Br J Plastic Surg. 2005;58:790-4.

https://doi.org/10.1016/j.bjps.2005.04.055

Vermeeren L, Klop WM, van den Brekel MW, Balm AJ, Nleweg OE, Valdés-Olmos RA. Sentinel node detection in head and neck malignancies: innovations in radioguided surgery. J Oncol. 2009:681746, doi:10.1155/2009/681746.

https://doi.org/10.1155/2009/681746

Vigili MG, Tartaglione SR, Mafera B, Pagan M. Lymphoscintigraphy and radioguided sentinel node biopsy in oral cavity squamous cell carcinoma: same day protocol. Eur Arch Otorhinolaryngol. 2007;264:163-7.

https://doi.org/10.1007/s00405-006-0150-7

Weinstein GS, Quon H, OM ́alley Jr BW, Kim GG, Cohen MA. Selective neck dissection and deintensified postoperative radiation and chemotherapy for oropharyngeal cancer: a subset analysis of the University of Pennsylvania transoral robotic surgery trial. Laryngoscope. 2010;120(9):1749-55.

https://doi.org/10.1002/lary.21021

Hans S, Jouffry T, Veivers D, Hoffman C, Girod A, Badoual C, Rodriguez J, Brasnu D. Transoral robotic-assisted free flap reconstruction after radiation therapy in hypopharyngeal carcinoma: report of two cases. Eur Arch Otorhinolaryngol. 2013;270:2359-64.

Pollei TR, Hinni ML, Moore EJ, Hayden RE, Olsen KD, Casler JD, et al. Analysis of postoperative bleeding and risk factors in transoral surgery of the oropharynx. JAMA Otolaryngol Head Neck surg. 2013;139(11):1212-8.

https://doi.org/10.1001/jamaoto.2013.5097

Hans S, Delas B, Gorphe P, Menard M, Brasnu D. Transoral robotic surgery in head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis. 2012;129:32-7.

https://doi.org/10.1016/j.anorl.2011.06.003

Bernier J, Cooper JS, Pajak TF, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (#9501). Head Neck. 2005;27(10):843-50.

https://doi.org/10.1002/hed.20279

Bernier J, Domenge C, Ozsahin M, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004;350(19):1945-52.

https://doi.org/10.1056/NEJMoa032641

Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004;350(19):1937-44.

https://doi.org/10.1056/NEJMoa032646

Publicado
2014-09-01
Sección
Artículos de revisión