Update on the survival results of robotic nasopharyngectomy: a prospective case series of 26 cases

Abstract

Introduction: Since 2010, the da Vinci surgical robot has been employed for resecting small centrally located tumors in the nasopharynx, mostly as salvage for recurrent nasopharyngeal carcinoma (NPC). The current study updates the result of robotic nasopharyngectomy. Materials and Methods: Prospective cohort of 26 patients who had undergone robotic nasopharyngectomy with or without combined endoscopic resection. Results: There are 26 operations on 24 patients, with 18 male and 6 female. 1 patient received a second operation for resection of positive inferior margin 4 weeks after the initial surgery and 1 patient had local recurrence 18 months after the first robotic nasopharyngectomy. 21 operations were done by pure robotic approach and 5 operations included endoscopic approach to remove the sphenoid floor (bony roof of nasopharynx). Median age of the patients is 55.5 (range 29-85) years. The median operating time is 232 (97-574) minutes. 6 patients had positive margin with one patient received re-resection of the positive margin. 3 of the remaining 5 patients received another course of radiotherapy for the positive margin. Median follow up of the cohort is 32 (range 2-71) months. The estimated mean local control is 52.8 months and estimated mean overall survival is 57.8 months. The 2-year local control rate is 77%. Positive margin is statistically significant risk factor for poor local control but not for overall survival. Conclusion: Robotic nasopharyngectomy is a feasible option for salvaging local recurrent NPC with comparable survival outcomes compared to other salvage options.