Transoral Endoscoic Surgery for Tonsil Cancer

faithful65
faithful65 Member Posts: 10
in Head and Neck Cancer #1

Does anyone have experience with this type of surgery?

John Hopkins is advocating surgery for early stage cancers of small size. 

Website says: Many patients with smaller tumors in the mouth, throat and voice box may be candidates for tumor removal through the mouth (transoral).  This is a minimally invasive technique that avoids incisions through the neck or face. These procedures result in less swelling, less scarring and a lower risk of infection. It also helps preserve function and appearance. Patients may be able to eat right after surgery, and even if their voice is affected it may be still be functional.   Our team has much experience in transoral surgery using both the laser and the surgical robot (transoral robotic surgery or TORS).  Johns Hopkins was the first center in Maryland to begin TORS and remains a leader in this area.

http://www.hopkinsmedicine.org/kimmel_cancer_center/centers/head_neck/cancers/treatment.html

Thank you,

Bob

Comments

  • phrannie51
    phrannie51 Member Posts: 4,716
    #2
    I think there are a few folks here

    who have had TORS surgery.....no names are coming to the surface of my brain right this minute....but that's par for the course for me Laughing.  I'm sure you'll be hearing from someone tho.....soon.

    p

  • fishmanpa
    fishmanpa Member Posts: 1,227 Member
    #3
    TORS

    I had TORS for ligual tonsil removal along with biopsies and a selective neck dissection at Johns Hopkins. They are one of the pioneers in this type of surgery. I can't speak highly enough about my team and treatment. I'm sure, had I not gone to JH for treatment, I wouldn't be here.

    Positive thoughts

    "T"

  • faithful65
    faithful65 Member Posts: 10
    #4
    fishmanpa said:

    TORS

    I had TORS for ligual tonsil removal along with biopsies and a selective neck dissection at Johns Hopkins. They are one of the pioneers in this type of surgery. I can't speak highly enough about my team and treatment. I'm sure, had I not gone to JH for treatment, I wouldn't be here.

    Positive thoughts

    "T"

    TORS

    T,

    What determined that surgery was appropriate?  Size and stage or other things?  Radiation and Chemo before or aafterwards?

    Bob

  • Rommotu
    Rommotu Member Posts: 4
    #5
    faithful65 said:

    TORS

    T,

    What determined that surgery was appropriate?  Size and stage or other things?  Radiation and Chemo before or aafterwards?

    Bob

    Tors

    I had robotic surgery at Mayo (Rochester) dec 12 because the surgeons felt the right side soft palate tumor (t1)  was small enough to insure clean margins and because negative Pet and Mri showed no hot lymph nodes. However, the surgeons were also wise enough to recommend a partial right neck dissection ( 29 nodes removed) to uncover microscancer lymph cancer not substantial enough to light up on pet or MRI . Sure enough one lymph showed capsulated cancer cells. Because of this i've chosen IMRT radiation starting jan 13 to zap any rogue, floating cells. By the way, I was out of the hospital after my 2.5 hour surgery after 2.5 days with mild sore throat, eating soft food for the first week and then eating all foods one week post discharge.

  • faithful65
    faithful65 Member Posts: 10
    #6
    Rommotu said:

    Tors

    I had robotic surgery at Mayo (Rochester) dec 12 because the surgeons felt the right side soft palate tumor (t1)  was small enough to insure clean margins and because negative Pet and Mri showed no hot lymph nodes. However, the surgeons were also wise enough to recommend a partial right neck dissection ( 29 nodes removed) to uncover microscancer lymph cancer not substantial enough to light up on pet or MRI . Sure enough one lymph showed capsulated cancer cells. Because of this i've chosen IMRT radiation starting jan 13 to zap any rogue, floating cells. By the way, I was out of the hospital after my 2.5 hour surgery after 2.5 days with mild sore throat, eating soft food for the first week and then eating all foods one week post discharge.

    TORS

    Is it standard to go with only radiation after TORS?  What is the basis for just radiation or a combination radiation/chemo?

  • fishmanpa
    fishmanpa Member Posts: 1,227 Member
    #7
    faithful65 said:

    TORS

    T,

    What determined that surgery was appropriate?  Size and stage or other things?  Radiation and Chemo before or aafterwards?

    Bob

    Factors

    Bob,

    I was Tx N2b, MO Stage IV.  I had my palatine tonsils removed along with biopsies locally last Christmas. All were clear of cancer. PET showed strong involvement in the lymph nodes left side. Initially, the ENT locally recommended chemo rads only. However, I wasn't comfortable with the doctors and the general "feel" so I sought a 2nd opinion at Johns Hopkins. After getting my 2nd opinion at JH and deciding I would seek treatment there, my team felt there was a strong chance 60+% of finding the primary somewhere in my neck/throat. To do so, TORS was suggested to remove the lingual tonsils and do further biopsies of several suspicious areas as well as a selective neck dissection to remove the cancer.

    Thus TORS for the tonsillectomy and biopsies. I posted a thread with photos of the surgery http://csn.cancer.org/node/255249. The neck dissection was done by conventional methods during the same procedure. What was supposed to be a 2-3 hour operation turned into a 6-7 hour procedure due to the extensive nature of the tumor's invasion of my neck. There were two very large (5+cm) tumors and another smaller that had wrapped themselves around the muscles, nerves and blood vessels in my neck and required a very tedious and complicated excision. 24 addidional nodes were removed as well. The tumors were HPV+ and extracapsular so I had chemo (6 weekly Cispplatin) along with 6 weeks (30) rads post surgery.

    The machine itself reminded me of an alien abduction scenario with the robotic arms and such. It was controlled like a video game. The view in the photos is from the monitor of the DaVinci Robot. Dr. Jeremy Richmon is my ENT/Surgeon. 

    Positive thoughts 

    "T"

  • PJ47
    PJ47 Member Posts: 376
    #8
    I had TORS for a small 1.5cm Base of Tongue SCC

    At Vanderbilt in Nashville Tenn. I considered having the surgery at Hopkins and  I also considered the laser surgery at Mayo in Jacksonville Florida.  I had one lymph node that was seen as involved in a PET/CT scan with FDG dye going into the surgery so a selective neck dissection was also done along with the TORS.  My surgeon Dr. Netterville, was excellent and initially thought I would not need further tretment as the margins were clear, but the lymph node had some small amt of spread after final pathology report so the "standard of care" was to then have radiation and/or chemo.  He recommended lower dose radiation due to clear margins, and I have completed it.  The TORS surgery was rough to recover from mainly due to poor pain control and I lost 20 lbs in 2 weeks.  I did bounce back after a month.  The neck dissection was also rough in terms of chronic nerve pain and weakness in my left shoulder and arm but I have about 75% range of motion now and no more nerve pain.

     The radiation which I completed last week (I chose TOMO/IMRT or IMGT) has been difficult as well with the typical side effects mentioned in the superthread by others. I had a lot of problems with the feeding tube surgery which my R/O was adamant I have, and had to have a second one put it.  I have not needed it and it has only caused me grief and pain.  

    Take one step at a time.  If the primary tumor is small and they can remove it with clear margins and they do not see/feel any involved lymph nodes, you may be able to avoid Radiation/chemo.  It all depends on the stage and mets.

    It is a hard decision to make, best of luck to you in this.

    PJ

  • debbiejeanne
    debbiejeanne Member Posts: 3,102 Member
    #9
    fishmanpa said:

    Factors

    Bob,

    I was Tx N2b, MO Stage IV.  I had my palatine tonsils removed along with biopsies locally last Christmas. All were clear of cancer. PET showed strong involvement in the lymph nodes left side. Initially, the ENT locally recommended chemo rads only. However, I wasn't comfortable with the doctors and the general "feel" so I sought a 2nd opinion at Johns Hopkins. After getting my 2nd opinion at JH and deciding I would seek treatment there, my team felt there was a strong chance 60+% of finding the primary somewhere in my neck/throat. To do so, TORS was suggested to remove the lingual tonsils and do further biopsies of several suspicious areas as well as a selective neck dissection to remove the cancer.

    Thus TORS for the tonsillectomy and biopsies. I posted a thread with photos of the surgery http://csn.cancer.org/node/255249. The neck dissection was done by conventional methods during the same procedure. What was supposed to be a 2-3 hour operation turned into a 6-7 hour procedure due to the extensive nature of the tumor's invasion of my neck. There were two very large (5+cm) tumors and another smaller that had wrapped themselves around the muscles, nerves and blood vessels in my neck and required a very tedious and complicated excision. 24 addidional nodes were removed as well. The tumors were HPV+ and extracapsular so I had chemo (6 weekly Cispplatin) along with 6 weeks (30) rads post surgery.

    The machine itself reminded me of an alien abduction scenario with the robotic arms and such. It was controlled like a video game. The view in the photos is from the monitor of the DaVinci Robot. Dr. Jeremy Richmon is my ENT/Surgeon. 

    Positive thoughts 

    "T"

    T, somehow i missed your post

    T, somehow i missed your post when you first posted it with the pics.  i also had neck dissection so seeing the pics were a reminder of what i went thru.  my left arm is still messed up as i can only lift it half way up.  can't use it to wash my hair b/c it won't go that high.  that will be forever but at least for now, I'm cancer free.  i'd have to say that the neck dissection was absolutely the worst part of my tx.  i also had 35 rad tx which were rough and i still have a few side effects, can't swallow right so food and pills get stuck, i eat veeerrrry slow to ensure food gets chewed real good so it can hoepfully be swallowed w/o a problem but i feel very fortunate that it isn't worse than that.  the worst part of cancer tx is the laryngectomy and the deformity of the neck dissection.  it's been almost 2 years and i am still adjusting to living as a lary.  it is NOT an easy life, but it is LIFE and I'm very blessed to be hear.  I also developed a fistula in my neck after the surgery which required another surgery.  the docs were extremely worried about the fistula as you can die from it.  that was another hell but again, i'm still here.  anyway, sorry for rambling, thank you for sharing your pics.  i'm sure it showed quite a few of us what we went thru.

    God bless you,

    dj

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