Kasim Durmus

Transoral robotic surgery for oropharyngeal cancer: long-term quality of life and functional outcomes.

IMPORTANCE Because treatment for oropharyngeal squamous cell carcinoma (OPSCC), especially in patients of older age, is associated with decreased patient quality of life (QOL) after surgery, demonstration of a less QOL-impairing treatment technique would improve patient satisfaction substantially. OBJECTIVE To determine swallowing, speech, and QOL outcomes following transoral robotic surgery (TORS) for OPSCC. DESIGN, PARTICIPANTS, AND SETTING This prospective cohort study of 81 patients with previously untreated OPSCC was conducted at a tertiary care academic comprehensive cancer center. INTERVENTIONS Primary surgical resection via TORS and neck dissection as indicated. MAIN OUTCOMES AND MEASURES Patients were asked to complete the Head and Neck Cancer Inventory (HNCI) preoperatively and at 3 weeks as well as 3, 6, and 12 months postoperatively. Swallowing ability was assessed by independence from a gastrostomy tube (G-tube). Clinicopathologic and follow-up data were also collected. RESULTS Mean follow-up time was 22.7 months. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 79%, 60%, 63%, and 67% respectively. There were overall declines in speech, eating, aesthetic, social, and overall QOL domains in the early postoperative periods. However, at 1 year post TORS, scores for aesthetic, social, and overall QOL remained high. Radiation therapy was negatively correlated with multiple QOL domains (P < .05 for all comparisons), while age older than 55 years correlated with lower speech and aesthetic scores (P < .05 for both). Human papillomavirus status did not correlate with any QOL domain. G-tube rates at 6 and 12 months were 24% and 9%, respectively. Greater extent of TORS (>1 oropharyngeal site resected) and age older than 55 years predicted the need for a G-tube at any point after TORS (P < .05 for both). CONCLUSIONS AND RELEVANCE Patients with OPSCC treated with TORS maintain a high QOL at 1 year after surgery. Adjuvant treatment and older age tend to decrease QOL. Patients meeting these criteria should be counseled appropriately.

Clinical outcomes of transoral robotic supraglottic laryngectomy

Transoral, minimally invasive organ preservation surgeries are being increasingly used for laryngopharyngeal carcinomas to avoid the toxicities of combined chemotherapy and radiation therapy regimens. This study investigates the efficiency, safety, and functional outcomes of transoral robotic surgery (TORS) supraglottic laryngectomy.

Transoral robotic approach to carcinoma of unknown primary.

The management of carcinoma of unknown primary (CUP) is one of the challenging conditions in head and neck oncologic surgery. Despite various diagnostic tools, the primary tumor site in more than half of cases remains unidentified. The purpose of this study was to assess the feasibility and efficiency of utilizing transoral robotic surgery (TORS) for the diagnosis and treatment of CUP in the head and neck.

Combined transoral robotic surgery and endoscopic endonasal approach for the resection of extensive malignancies of the skull base.

Oncologic resection of the clivus, nasopharynx, craniovertebral junction, and infratemporal fossa is a challenging endeavor because of their complex and protected anatomy. Our goals were to design a cadaveric model and identify advantages and limitations of combining the transoral robotic surgery (TORS) and endoscopic endonasal approach (EEA) techniques.

Surgical management of oropharyngeal squamous cell carcinoma: Survival and functional outcomes

The purpose of this study was to further define the impact of primary surgery in the management of oropharyngeal squamous cell carcinoma (SCC).

Functional and quality-of-life outcomes of transoral robotic surgery for carcinoma of unknown primary

To determine speech, eating, aesthetics, social disruption, and overall quality‐of‐life outcomes over a year period in patients who underwent transoral robotic surgery as part of carcinoma of unknown primary diagnosis and treatment.

Applications of transoral, transcervical, transnasal, and transpalatal corridors for Robotic surgery of the skull base

INTRODUCTION Endoscopic endonasal approaches (EEAs) provide an alternative surgical corridor to treat benign and malignant lesions of the sinonasal tract and skull base. According to the extent of the lesion and the surgical team experience, an endoscopic endonasal skull base approach can provide exposure of vital neurovascular structures and enable the surgeon to resect the lesion safely and completely. Similarly, robotic-assisted surgery facilitates the performance of highly complex surgeries in areas of the upper aerodigestive tract that are relatively difficult to access or to manipulate instruments, such as the oral cavity, nasopharynx, oropharynx or hypopharynx, supraglottis, glottis, parapharyngeal space and infratemporal fossa (ITF). Operative time and time of hospitalization are superior to those associated with open approaches and are associated with less morbidity. Various feasibility studies have suggested that robotic-assisted surgery may be applied to skull base surgery with similar results. In general, skull base surgery is difficult and complex due to its anatomical intricacies, deep-seated nature, and the presence of adjacent vital structures. In addition, the relative rarity of indications increases the difficulty for a surgeon to become familiar with the detailed anatomy and the various pathologies affecting the region. This study was undertaken to better define and understand the potential use and limitations of current robotic approaches to the skull base.

Safety and efficacy of concurrent neck dissection and transoral robotic surgery

The literature is scarce regarding transoral robotic surgery (TORS) with simultaneous neck dissection. This study evaluates the safety and efficacy of concurrent neck dissection in oropharyngeal squamous cell carcinoma (SCC) treated with TORS.

Evaluation of hearing in patients with familial Mediterranean fever

Familial Mediterranean fever (FMF) is a common and well-understood hereditary periodic fever syndrome. Hereditary periodic fever syndromes include a group of multisystem diseases characterized by recurrent fever attacks with inflammation affecting skin, joints, and some other tissues. These are FMF, tumor necrosis factor receptor, tumor necrosis factor receptor associated periodic syndrome, hyperimmunglobulinemia D syndrome, Muckle–Wells syndrome, and familial cold urticaria. In literature, it is determined that some of these diseases cause hearing loss. In light of the foregoing, we thought that FMF patients may have the same type of subclinical hearing loss and, therefore, the hearing ability of these patients was evaluated with otoacoustic emission and high frequency audiometry tests.

Transoral robotic supraglottic laryngectomy: Surgical considerations

Transoral robotic surgery (TORS) has emerged as a novel, safe, and feasible procedure for the resection of supraglottic laryngeal cancers. The purpose of this study was to demonstrate the surgical technique for TORS supraglottic laryngectomy (SGL).