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Transoral Robotic Surgery: A Review of Clinical and Cost-Effectiveness

Published on: January 12, 2015
Project Number: RC0621-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of TORS for patients with early stage oral or oropharyngeal cancer?
  2. What is the clinical effectiveness of TORS for patients with OSA?
  3. What is the cost-effectiveness of TORS for patients with early stage oral or oropharyngeal cancer?
  4. What is the cost-effectiveness of TORS for patients with OSA?

Key Message

The evidence addressing the clinical effectiveness of TORS in the management of early stage oral and oropharyngeal cancer is of limited quality. Health technology assessments (HTA) and systematic reviews included in the report were limited to studies with case-series design. Registry studies show that compared to open or non-robotic approaches, TORS confers no mortality benefit but reduces the duration of hospitalization. The benefits of TORS on the reduction in the need for gastrostomy and tracheostomy tubes and post-operative dysphagia are conflicting. There does not appear to be a reduction in bleeding complications associated with TORS. No evidence regarding the clinical or cost effectiveness of TORS in the management of OSA was identified. No studies addressing the cost-effectiveness of TORS in the management of early stage oral and oropharyngeal cancer were identified. Compared to conventional surgical approaches, evidence from non-randomized studies is conflicting as to whether TORS offers cost savings. An activity-based cost calculation found that the total cost of TORS was more than conventional surgery, however the cost differences were attributed to initial purchase costs as well as ongoing training and equipment maintenance.

Tags

mouth neoplasms, oropharyngeal neoplasms, pharyngeal neoplasms, robotics, sleep apnea syndromes, cancer, sleep apnea, obstructive, medical devices, respiratory, surgery, transoral robotic surgery, trans oral robotic surgery, TORS, Sleep apnoea, OSA, Sleep Apnea, Obstructive