Background/Objective: The incidence of oropharyngeal cancer (OPC) remains significant, with a rising prevalence of HPV-positive (HPV+) cases, underscoring the growing importance of appropriate treatment approaches for this condition. While HPV+ OPC typically exhibits a more favorable prognosis than HPV-negative (HPV-) OPC, certain HPV+ OPC patients still face adverse outcomes. This study aimed to assess the effectiveness of TORS versus traditional surgery in treating OPC patients and investigate the prognostic implications of specific variants in the HPV genome. Methods: The clinical information, including pathological features, treatments, and outcomes (death), of 135 OPC patients treated with traditional surgery from 2008 to 2018 (the non-TORS group) and 130 OPC patients treated with TORS from 2017 to 2021 (the TORS group) were obtained from Sun Yat-sen University Cancer Center (SYSUCC). A comparative analysis of 3-year overall survival (OS) was performed between these two groups. Furthermore, we conducted next-generation sequencing for the HPV16 genome of the 68 HPV+ OPC cases to characterize single-nucleotide variations (SNVs) in the HPV16 genome and evaluate its association with HPV+ OPC patient survival. Results: The comparative analysis of 3-year OS between the two groups (TORS vs. non-TORS) revealed a significant prognostic improvement in the TORS group for OPC patients with a T1-T2 classification (89.3% vs. 72.0%; p = 1.1 × 10-2), stages I-II (92.1% vs. 82.2%; p = 4.6 × 10-2), and stages III-IV (82.8% vs. 62.2%; p = 5.7 × 10-2) and for HPV- patients (85.5% vs. 33.3%; p < 1.0 × 10-6). Furthermore, three SNVs (SNV1339A>G, SNV1950A>C, and SNV4298A>G) in the HPV16 genome were identified as being associated with worse survival. These SNVs could alter protein interactions and weaken the binding affinity for MHC-II, promoting viral amplification and immune evasion. Conclusions: TORS exhibited a superior prognosis to traditional surgery in OPC patients. Additionally, identifying specific SNVs within the HPV16 genome provided potential prognostic markers for HPV+ OPC. These significant findings hold clinical relevance for treatment decision-making and prognostic assessment in patients with OPC.

OBJECTIVE: To analyze oncological and functional results of transoral minimally invasive surgery (TMIS) for supraglottic laryngeal carcinoma (SGLC), and investigate independent prognostic factors.
METHODS: Seventy SGLC patients treated with TMIS were included. The overall survival (OS), recurrence-free survival (RFS), and postoperative functions were analyzed.
RESULTS: Sixty-two patients were early-stage (Tis, T1, and T2) and eight patients were T3. Eleven patients received preoperative induction chemotherapy (IC). Sixty patients received transoral laser microsurgery (TLM), and 10 patients received transoral robotic surgery (TORS). Fifty-eight patients were scored Grade-1 by water swallow test, and 49 patients were scored Grade 0 by grade, roughness, breathiness, asthenia, strain. The 1, 3, and 5 year OS of all were 95.450%, 84.877%, and 78.026%, and RFS were 89.167%, 78.052%, and 75.451% respectively. Kaplan-Meier survival analysis showed N stage and clinical stage were associated with OS, smoking, clinical stage, surgical margins, and Ki-67 index were associated with RFS. There were no significant differences in preoperative IC or direct surgery, TLM, or TORS. Cox analyses showed smoking and surgical margins were independent prognosis factors for RFS.
CONCLUSIONS: The positive margin, Ki-67 index ≥40% and P53(+)&Ki-67 index ≥40% are worse factors affecting recurrence for SGLC patients. Both smoking and surgical margins are independent prognostic factors affecting recurrence.

BACKGROUND: Squamous cell carcinoma of unknown primary (CUP) in the head and neck is difficult to diagnose and treat. This report outlines 11 cases of CUP treated with transoral robotic surgery (TORS), aimed at investigating the diagnostic efficiency of primary tumour and radical resection effectiveness of TORS.
METHODS: 11 cases of CUP among 68 oropharyngeal cancer patients treated by TORS were analysed retrospectively.
RESULTS: All the 11 cases received TORS with cervical lymph node dissection. Primary tumours were found in 8 cases (72.7%), 4 cases in the palatine tonsil and 4 cases in the base of the tongue. The average diameter of the primary tumour was 1.65 cm. All patients resumed eating by mouth within 24 h, no tracheotomy, no pharyngeal fistula and no postoperative death. The 3-year disease-free survival rate was 91%.
CONCLUSIONS: TORS can improve the diagnostic efficiency of primary tumour of CUP and achieve good oncology and functional results.

OBJECTIVE: Continuum manipulators (CMs) show great potential in transoral laryngeal surgery due to their flexibility. However, CMs for transoral surgery face several issues: large size, which reduces practicality; intersegment coupling, which causes undesired deflection; and a lack of versatility that limits their applicability across different patient groups.
METHODS: This work combines a rod-driven proximal segment and a cable-driven distal segment to achieve piecewise stiffness, alleviating the issue of intersegment coupling. A rigid constraint tube is integrated into the proximal segment to diversify its bending behavior. Preliminary experiments are conducted to validate the design concept.
RESULTS: The proposed CM has an overall diameter of only 6.5 mm. The proximal segment can achieve a 90° bending with various curvatures. At the working configuration, the coupling error between the proximal segment and the distal segment is less than 1 mm. The effectiveness of the proposed CM is successfully validated using a human model.
CONCLUSIONS: The proposed continuum manipulator possesses the desirable characteristics of small size, low coupling, and high versatility, indicating its great potentialities for the diagnosis and treatment of laryngeal lesion.

To explore the clinical diagnosis and treatment experience of isolated fibrotic tumor （SFT） occurring in the larynx, hypopharynx and esophageal inlet with a wide range.The patient, admitted to the Department of Otolaryngology-Head and Neck Surgery of Tangdu Hospital of Air Force Medical University was a female aged at 78 years, who was diagnosed with SFT primarily occured at laryngeal, hypopharynx and esophageal entrance. The clinical data, surgical methods, histopathology characteristics of the patient were analyzed respectively. It\'s proved that a tumor sized about 3.8 cm×2.8 cm×2.0 cm with slippy surface was found at the entrance of the laryngeal, hypopharynx and esophageal entrance, covering the laryngeal vestibule, glottis and right piriform fossa, which was completely resected by transoral robotic surgery. The postoperative pathological diagnosis was SFT. The patient recovered well after surgery and showed no recurrence within 16-month follow-up. SFT occurring in the larynx, hypopharynx, and esophageal inlet is very rare, and transoral da Vinci robotic surgical resection of the tumor in this area is feasible, and has the advantages of clear field of vision, less bleeding, less trauma, fewer complications, and quicker postoperative recovery.
摘要: 探讨发生于喉、下咽及食管入口范围较广孤立性纤维性肿瘤（solitary fibrotic tumor，SFT）的临床诊治经验。分析空军军医大学唐都医院耳鼻咽喉头颈外科收治的1例女性患者（78岁），原发于喉、下咽、食管入口的SFT患者的临床资料、手术方式及病理组织学特征，并复习相关文献。患者喉、下咽、食管入口处有大小约3.8 cm×2.8 cm×2.0 cm表面光滑肿物，遮挡喉前庭、声门及右侧梨状窝，经口达芬奇机器人完整切除肿瘤，并同时缝合修复下咽创面，术后病理诊断为SFT。患者术后恢复良好，随访16个月未见复发。 结论：发生于喉、下咽、食管入口的SFT非常少见，经口达芬奇机器人手术切除该部位的肿瘤是可行的，而且具有视野清晰、出血少、创伤小、并发症少、术后恢复快等优点。.

To compare the effectiveness of transoral robotic surgery (TORS) and non-robotic surgeries (NRES) in patients with oropharyngeal squamous cell carcinoma (OPSCC), medical databases were searched including PubMed, Web of Science, Medline, Embase, and Cochrane Library up to January 2023. The methodology follows PRISMA guidelines, including the PRISMA flow diagram. Data from the included studies were extracted independently by two researchers. Seven studies involving five hundred seventy-seven patients were included. Of these, 275 underwent TORS and 302 underwent NRES. The disease-free survival rate was significantly higher in the TORS group than in the NRES group (OR = 3.43, 95% CI 1.92-6.15, P < 0.0001). However, there were no significant differences in positive surgical margins, hospital stays, operation time, blood loss, postoperative bleeding rate, perioperative tracheostomy, perioperative feeding tube, and overall survival rate. These findings can initially guide the preoperative counseling of TORS in patients with OPSCC, and preliminarily confirm that the adoption of TORS deserves careful consideration.

UNASSIGNED: Transoral robotic surgery (TORS) has become an effective treatment for early-stage oropharyngeal squamous cell carcinomas (OPSCCs). We aimed to analyze the clinical safety and efficacy of TORS for human papilloma virus (HPV)-positive and HPV-negative OPSCC in China.
UNASSIGNED: Patients with OPSCC of pT1-T2 stage who underwent TORS from March 2017 to December 2021 were analyzed.
UNASSIGNED: A total of 83 patients (HPV-positive, n = 25; HPV-negative, n = 58) were included. The median age of the patients was 57.0 years and 71 were men. The majority of primary tumor sites were palatine tonsils (52, 62.7%) and base of tongues (20, 24.1%). Three patients have a positive margin. A total of 12 (14.5%) patients received tracheotomies, the average duration of tracheostomy tube use was 9.4 days, and nasogastric tube was 14.5 days. No patient had a long-term tracheotomy. The 3-year overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) for all 83 patients were 89.5%, 80.1%, and 83.3%, respectively. The OS at 3 years between the HPV-positive group and HPV-negative group were 100% versus 84.3% (P = .07), while the DFS and RFS between two groups also showed no significant difference. Among multivariate cox regression analysis of all potential risk factors, smoking was the significant risk factors for disease recurrence (P < .05).
UNASSIGNED: Transoral robotic surgery achieved encouraging oncologic outcomes and safety in T1-T2 stage OPSCC treatment, regardless of HPV status.
UNASSIGNED: 4.

UNASSIGNED: There is no evidence about the relationship between surgical cavity drainage and related postoperative complications in transoral robotic surgery (TORS) resected parapharyngeal space (PPS) tumors.
UNASSIGNED: To investigate the clinical efficacy and advantage of transnasal PPS drainage to prevent surgical cavity related complications (SCRC) in TORS resected PPS tumors.
UNASSIGNED: Twenty-three patients undergoing TORS for PPS tumors were identified. In the experimental group (EG, 8 patients), the surgical incision was sutured directly and the transnasal drainage tube was placed. In the control group (CG, 15 patients), the surgical incision was partially sutured without drainage. The healing grade of surgical incision (HGSI), healing grade of surgical cavity (HGSC), SCRC, and other complications were compared.
UNASSIGNED: There were significant statistical differences in postoperative clinical rehabilitation indexes (HGSI/HGSC/SCRC) between the two groups. The comparison results of HGSI and HGSC in the two groups (EG vs CG) were (100% vs 66.7%) and (100% vs 46.7%) respectively. Compared with the EG, eight cases (53.3%) in the CG had postoperative SCRC such as hemorrhage, effusion, and swollen.
UNASSIGNED: For TORS resected PPS tumors, transnasal PPS drainage is an effective and comfortable method to improve postoperative HGSI and HGSC and prevent SCRC.

Surgery remains the mainstay treatment for parapharyngeal space (PPS) tumors. Given the rapid advance and increasing usage of endoscopic and robotic techniques, we aimed to investigate the surgical trends of PPS tumors in our institution and analyze their impact on patients\' treatment outcomes.
All patients who underwent surgical resection of PPS tumors from 2014 to 2021 at the Eye, Ear, Nose, and Throat Hospital of Fudan University were retrospectively reviewed. Student\'s t-test, Chi-square test, and multinomial logistic regression analyses were used to compare the surgical outcomes between groups.
Of the included 389 patients, the recipients of endoscopic surgery have largely increased in our center, with 17 of 134 cases (12.7%) in the group 2014-2017 and 187 of 255 cases (73.3%) in the group 2018-2021. The use of transoral and trans-nasal approaches increased in recent years (5.2% in 2014-2017 vs. 26.0% in 2018-2021), while that of trans-mandibular and lateral skull base approaches decreased (5.9% in 2014-2017 vs. 0.8% in 2018-2021). Decreased blood loss of operation and decreased risks of postoperative neurovascular complications were observed in the group 2018-2021. Similar findings were observed among patients receiving endoscopic surgery when compared with those receiving conventional surgery.
In our institution, the overall trends in the surgical management of PPS tumors moved towards minimally invasive approaches with the assistance of endoscopy or surgical robots. The two surgical techniques were feasible and safe, and to a great extent, contributed to the improved surgical outcomes we observed in recent years.

Objective:This study investigated the clinical indications, prevention and management of common complications of TORS resection of parapharyngeal space tumors. Methods:The clinical data of 23 patients with parapharyngeal space tumors treated with TORS in the Eye & ENT Hospital of Fudan University from July 2020 to February 2022 were retrospectively analyzed. The surgical methods were divided into simple TORS surgery and TORS combined endoscopic or cervical surgery. The surgical incision can be directly sutured or partially sutured. If the surgical cavity is below the oropharyngeal plane and there is a risk of airway compression, preventive tracheotomy would be performed. No drainage（15 cases） or transnasal negative pressure drainage tube（8 cases） was placed in the operation cavity. In 17 cases, tumors were located between the top of nasopharynx and the lower boundary of oropharynx and these patients underwent simple TORS surgery; one case received combined cervical and endoscopic surgery, as the tumor was located near the skull base with unclear boundary with the deep lobe of parotid gland; five cases underwent combined endoscopic surgery, as the tumor reached the upper part of the nasopharynx or the outer part of the parapharyngeal space. Results:One case underwent emergency hemostasis for postoperative bleeding, and three cases underwent puncture and drainage for postoperative effusion. No complication occurred such as postoperative infection and airway obstruction. The healing grade of surgical incision and surgical cavity in transnasal drainage group was significantly better than that in non-drainage group. Conclusion:TORS operation is a safe and minimally invasive method in treating parapharyngeal space tumors with appropriate size and location. Postoperative effusion is a common complication after TORS. In case that surgical cavity extends to the deep parapharyngeal space or the lower part of the surgical cavity is beneath the surgical incision, the placement of transnasal negative pressure drainage tube after operation can improve postoperative recovery and reduce the incidence of complications such as effusion and infection.
目的：探讨经口机器人手术（TORS）切除咽旁间隙肿瘤的临床适应证及常见并发症的预防和处理。 方法：回顾性分析2020年7月—2022年2月在复旦大学附属眼耳鼻喉科医院行TORS治疗的23例咽旁间隙肿瘤患者的临床资料，手术分为单纯TORS手术和TORS联合内镜或经颈手术。手术切口采取直接缝合或部分缝合。对术腔靠近口咽平面以下有压迫气道风险者行预防性气管切开。根据术腔是否放置引流管分为引流组8例，非引流组15例。23例患者中，17例肿瘤位于鼻咽顶水平及口咽下界水平之间，行单纯TORS手术切除肿瘤；1例肿瘤近颅底且上极和腮腺深叶边界不清行TORS联合经颈及内镜手术；5例瘤体超过鼻咽顶水平行TORS联合内镜手术。 结果：仅1例术后术腔出血即行紧急止血，3例术后术腔积液即行穿刺及扩开排液。患者均未出现术腔感染、气道阻塞等并发症。引流组的切口及术腔愈合明显优于非引流组。 结论：TORS对于大小和部位适合的咽旁间隙肿瘤是一种安全微创的手术方法。术腔积液是TORS术后常见并发症，对于术腔较大且向咽旁深部延伸或术腔的下方低于手术切口下方的肿瘤，术后放置经鼻负压引流管能够促进口咽黏膜切口及术腔的愈合，减少积液感染术腔并发症的发生。.