Association of transoral robotic surgery with short-term and long-term outcomes and costs of care in oropharyngeal cancer surgery

IMPORTANCE The treatment of oropharyngeal cancer has undergone a paradigm shift in the past 2 decades, with an increase in the use of nonoperative treatment owing to poor functional outcomes associated with traditional surgical approaches. Transoral robotic surgery (TORS) allows surgical resection of oropharyngeal cancer (OPC) with less morbidity through a minimally invasive approach. OBJECTIVE To investigate the relationship among TORS and short- and long-term outcomes and costs in surgically treated patients with OPC. DESIGN, SETTING, AND PARTICIPANTS Retrospective cross-sectional analysis of 3573 patients who underwent an ablative procedure for OPC in 2010 to 2012 using the MarketScan Commercial Claim and Encounters database. MAIN OUTCOMES AND MEASURES The association between TORS and short- and long-term outcomes, length of hospitalization, and treatment-related costs was analyzed using descriptive statistics and multivariate regression modeling. RESULTS Transoral robotic surgery was performed in 304 surgical cases (8.5%); 94.7%of patients were 40 to 64 years old, and 70.7%were male. The use of TORS increased from 4.1% of surgical cases in 2010 to 13.2%of surgical cases in 2012. Patients who underwent TORS had a lower rate of tracheotomy during treatment (3.9%vs 11.4%), and posttreatment gastrostomy tube use (21.9%vs 34.2%), compared with patients undergoing non-TORS procedures. On multivariate analysis, TORS was not associated with significant differences in postoperative complications or length of hospitalization. There was no significant difference in the odds of receiving postoperative radiation therapy between patients who underwent TORS and those who did not; however, among patients receiving radiation therapy, chemoradiation was significantly less likely following TORS (odds ratio [OR], 0.52; 95%CI, 0.29-0.90). TORS was associated with significantly decreased odds of posttreatment gastrostomy (OR, 0.54; 95%CI. 0.30-0.95) and tracheostomy during treatment (OR, 0.17; 95%CI, 0.06-0.55) at 1 year, and was associated with significantly decreased overall treatment-related costs of care (mean incremental cost, -$22 724). CONCLUSIONS AND RELEVANCE The use of TORS for surgical resection of OPC is increasing in the United States and is associated with significantly lower use of adjuvant chemoradiation, late gastrostomy and tracheostomy dependence, and lower overall treatment-related costs of care. These data have implications for discussions of value in OPC care at a time of health care reform.