机器人手术在口咽癌中的应用进展

doi:10.19438/j.cjoms.2025.06.014

摘要/Abstract

摘要： 本研究系统阐述经口机器人手术（trans oral robotic surgery,TORS）在口咽癌治疗中的应用现状及研究进展,详细剖析TORS的适应证、禁忌证及术后并发症。与传统开放性手术相比,TORS在视野清晰度、操作精准度、美观满意度等方面具有显著优势。临床数据表明,TORS在早期及部分晚期口咽癌中展现出良好的肿瘤控制率与生存预后,尤其在HPV相关口咽癌及原发灶不明颈部鳞癌的诊疗中疗效突出。同时也指出了TORS目前缺乏触觉反馈、设备复杂及成本高昂等不足的问题。未来展望聚焦单孔机器人系统、柔性机械臂技术及术中荧光导航成像等创新方向,上述技术革新有望通过拓展解剖适应范围、优化肿瘤边界识别能力,进一步提升口咽癌治疗的肿瘤学疗效与功能预后。

关键词: 口咽癌, 头颈部鳞癌, 达·芬奇手术机器人, 微创外科, 肿瘤治疗

Abstract: This study systematically expounded the application status and research progress of trans oral robotic surgery (TORS) in the treatment of oropharyngeal cancer. It elaborated on the indications, contraindications, and postoperative complications of TORS. Compared with traditional open surgery, TORS had significant advantages in terms of visual clarity, operational precision, and aesthetic satisfaction. Clinical data showed that TORS demonstrates good tumor control rates and survival outcomes in early-stage and some advanced-stage oropharyngeal cancers, especially in the diagnosis and treatment of HPV-related oropharyngeal cancers and cervical squamous cell carcinomas of unknown primary origin. At the same time, it also pointed out the shortcomings of TORS, such as the lack of tactile feedback, equipment complexity, and high costs. Future prospects focused on innovative directions such as single-port robotic systems, flexible robotic arm technology, and intraoperative fluorescence navigation imaging. These technological innovations are expected to further improve the oncological efficacy and functional prognosis of oropharyngeal cancer treatment by expanding the scope of anatomical adaptation and optimizing tumor boundary recognition capabilities.

Key words: Oropharyngeal cancer, Head and neck squamous cell carcinoma, da Vinci surgical robot, Minimally invasive surgery, Tumor treatment

中图分类号:

R739.8
R782

林权泉, 席庆. 机器人手术在口咽癌中的应用进展[J]. 中国口腔颌面外科杂志, 2025, 23(6): 627-634.

Lin Quanquan, Xi Qing. Advances in the application of robotic surgery in oropharyngeal cancer[J]. China J Oral Maxillofac Surg, 2025, 23(6): 627-634.

参考文献

[1] 席庆. 舌根肿瘤, 开放手术还是机器人手术?[J]. 中国口腔颌面外科杂志, 2022, 20(6): 527-533.
Xi Q.Tongue base tumor, open surgery or transoral robotic surgery?[J]. China Journal of Oral and Maxillofacial Surgery, 2022, 20(6): 527-533.
[2] 于文俊, 席庆. 达·芬奇机器人在口腔颌面外科中的应用[J]. 中华老年口腔医学杂志, 2021, 19(6): 360-364.
Yu WJ, Xi Q.Application of Da Vinci robot in oral and maxillofacial surgery[J]. Chinese Journal of Geriatric Dentistry, 2021, 19(6): 360-364.
[3] Wang P, Su YJ, Jia CY.Current surgical practices of robotic-assisted tissue repair and reconstruction[J]. Chin J Traumatol, 2019, 22(2): 88-92.
[4] Rinaldi V, Pagani D, Torretta S, et al.Transoral robotic surgery in the management of head and neck tumours[J]. Ecancermedicalscience, 2013, 7: 359.
[5] 席庆, 张明, 冯琳, 等. 9 例经口入路机器人手术在口腔颌面外科应用报道[J]. 中国口腔颌面外科杂志, 2020, 18(4): 365-368.
Xi Q, Zhang M, Feng L, et al.Application of transoral robotic surgery in oral and maxillofacial surgery:a report of 9 cases[J]. China Journal of Oral and Maxillofacial Surgery, 2020, 18(4): 365-368.
[6] Nakayama M, Holsinger FC, Chevalier D, et al.The dawn of robotic surgery in otolaryngology-head and neck surgery[J]. Jpn J Clin Oncol, 2019, 49(5): 404-411.
[7] Bekeny JR, Ozer E.Transoral robotic surgery frontiers[J]. World J Otorhinolaryngol Head Neck Surg, 2016, 2(2): 130-135.
[8] Weinstein GS, O'Malley BW Jr, Snyder W, et al. Transoral robotic surgery: radical tonsillectomy[J]. Arch Otolaryngol Head Neck Surg, 2007, 133(12): 1220-1226.
[9] Moore EJ, Olsen KD, Kasperbauer JL.Transoral robotic surgery for oropharyngeal squamous cell carcinoma: a prospective study of feasibility and functional outcomes[J]. Laryngoscope, 2009, 119(11): 2156-2164.
[10] 徐成志, 吴春萍, 薛继尧, 等. 达·芬奇 Xi 手术机器人在经口咽喉肿瘤手术中的可行性及围手术期安全性探讨[J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(5): 565-571.
Xu CZ, Wu CP, Xue JY, et al.Feasibility and perioperative safety of transoral robotic surgery with da Vinci Xi platform[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2022, 57(5): 565-571.
[11] Weinstein GS, O'malley BW Jr, Hockstein NG. Transoral robotic surgery: supraglottic laryngectomy in a canine model[J]. Laryngoscope, 2005, 115(7): 1315-1319.
[12] 孟令照, 房居高, 王建宏, 等. 达·芬奇机器人经口切除喉及下咽肿瘤的初步经验[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(14): 1065-1070.
Meng LZ, Fang JG, Wang JH, et al.Preliminary experience of transoral robotic surgery in laryngeal and hypopharyngeal tumors with da Vinci surgical system[J]. Journal of Clinical Otorhinolaryngology Head And Neck Surgery, 2018, 32(14): 1065-1070.
[13] Weinstein GS, O'Malley BW Jr, Snyder W, et al. Transoral robotic surgery: supraglottic partial laryngectomy[J]. Ann Otol Rhinol Laryngol, 2007, 116(1): 19-23.
[14] Park YM, Kim WS, Byeon HK, et al.Feasiblity of transoral robotic hypopharyngectomy for early-stage hypopharyngeal carcinoma[J]. Oral Oncol, 2010, 46(8): 597-602.
[15] Meccariello G, Cammaroto G, Iannella G, et al.Transoral robotic surgery for oropharyngeal cancer in the era of chemoradiation therapy[J]. Auris Nasus Larynx, 2022, 49(4): 535-546.
[16] Weinstein GS, O'Malley BW Jr, Magnuson JS, et al. Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins[J]. Laryngoscope, 2012, 122(8): 1701-1707.
[17] Vergez S, Lallemant B, Ceruse P, et al.Initial multi-institutional experience with transoral robotic surgery[J]. Otolaryngol Head Neck Surg, 2012, 147(3): 475-481.
[18] Byeon HK, Holsinger FC, Kim DH, et al.Feasibility of robot-assisted neck dissection followed by transoral robotic surgery[J]. Br J Oral Maxillofac Surg, 2015, 53(1): 68-73.
[19] Arora A, Kotecha J, Acharya A, et al.Determination of biometric measures to evaluate patient suitability for transoral robotic surgery[J]. Head Neck, 2015, 37(9): 1254-1260.
[20] Lee SJ, Lee JN, Kim TS, et al.The relationship between the predictors of obstructive sleep apnea and difficult intubation[J]. Korean J Anesthesiol, 2011, 60(3): 173-178.
[21] Shah PN, Sundaram V.Incidence and predictors of difficult mask ventilation and intubation[J]. J Anaesthesiol Clin Pharmacol, 2012, 28(4): 451-455.
[22] Tuzuner-Oncul AM, Kucukyavuz Z.Prevalence and prediction of difficult intubation in maxillofacial surgery patients[J]. J Oral Maxillofac Surg, 2008, 66(8): 1652-1658.
[23] Chi AC, Day TA, Neville BW.Oral cavity and oropharyngeal squamous cell carcinoma: an update[J]. CA Cancer J Clin, 2015, 65(5): 401-421.
[24] Yeh DH, Tam S, Fung K, et al.Transoral robotic surgery vs. radiotherapy for management of oropharyngeal squamous cell carcinoma-a systematic review of the literature[J]. Eur J Surg Oncol, 2015, 41(12): 1603-1614.
[25] De Virgilio A, Costantino A, Mercante G, et al.Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis[J]. Eur Arch Otorhinolaryngol, 2021, 278(5): 1321-1335.
[26] Mercante G, Ruscito P, Pellini R, et al.Transoral robotic surgery for tongue base tumours[J]. Acta Otorhinolaryngol Ital, 2013, 33(4): 230-235.
[27] Kayhan FT, Kaya H, Yazici ZM.Transoral robotic surgery for tongue-base adenoid cystic carcinoma[J]. J Oral Maxillofac Surg, 2011, 69(11): 2904-2908.
[28] Kayhan FT, Yigider AP, Koc AK, et al.Treatment of tongue base masses in children by transoral robotic surgery[J]. Eur Arch Otorhinolaryngol, 2017, 274(9): 3457-3463.
[29] 于文俊, 林权泉, 冯琳, 等. 经口机器人与非机器人手术治疗舌根肿瘤的疗效对比[J]. 机器人外科学杂志(中英文), 2024, 5(5): 952-958.
Yu WJ, Lin QQ, Feng L, et al.Comparative study on the efficacy of transoral robotic surgery and non-robotic surgery for tongue base tumors[J]. Chinese Journal of Robotic Surgery, 2024, 5(5): 952-958.
[30] Awad MI, Shuman AG, Montero PH, et al.Accuracy of administrative and clinical registry data in reporting postoperative complications after surgery for oral cavity squamous cell carcinoma[J]. Head Neck, 2015, 37(6): 851-861.
[31] D'Agostino MA.Transoral robotic partial glossectomy and supraglottoplasty for obstructive sleep apnea[J]. Otolaryngol Clin North Am, 2016, 49(6): 1415-1423.
[32] Vicini C, Montevecchi F, Gobbi R, et al.Transoral robotic surgery for obstructive sleep apnea syndrome: principles and technique[J]. World J Otorhinolaryngol Head Neck Surg, 2017, 3(2): 97-100.
[33] Hay A, Migliacci J, Karassawa Zanoni D, et al.Complications following transoral robotic surgery (TORS): a detailed institutional review of complications[J]. Oral Oncol, 2017, 67: 160-166.
[34] Su HK, Ozbek U, Likhterov I, et al.Safety of transoral surgery for oropharyngeal malignancies: an analysis of the ACS NSQIP[J]. Laryngoscope, 2016, 126(11): 2484-2491.
[35] Hirshoren N, Ruskin O, Fua T, et al.Transoral robotic surgery: implementation as a tool in head and neck surgery-a single-centre Australian experience[J]. ANZ J Surg, 2018, 88(11): 1129-1134.
[36] Sethi RKV, Chen MM, Malloy KM.Complications of transoral robotic surgery[J]. Otolaryngol Clin North Am, 2020, 53(6): 1109-1115.
[37] Chen MM, Holsinger FC.Morbidity and mortality associated with robotic head and neck surgery: an inquiry of the food and drug administration manufacturer and user facility device experience database[J]. JAMA Otolaryngol Head Neck Surg, 2016, 142(4): 405-406.
[38] Wilson JA, Carding PN, Patterson JM.Dysphagia after nonsurgical head and neck cancer treatment: patients' perspectives[J]. Otolaryngol Head Neck Surg, 2011, 145(5): 767-771.
[39] Hunter KU, Lee OE, Lyden TH, et al.Aspiration pneumonia after chemo-intensity-modulated radiation therapy of oropharyngeal carcinoma and its clinical and dysphagia-related predictors[J]. Head Neck, 2014, 36(1): 120-125.
[40] Chia SH, Gross ND, Richmon JD.Surgeon experience and complications with Transoral Robotic Surgery (TORS)[J]. Otolaryngol Head Neck Surg, 2013, 149(6): 885-892.
[41] 郭传瑸. 颅颌面外科医疗机器人的研发与应用任重道远[J]. 中华口腔医学杂志, 2018, 53(8): 505-507.
Guo CB.Development and application of robots in craniomaxillofacial surgery remains a long and arduous task[J]. Chinese Journal of Stomatology, 2018, 53(8): 505-507.
[42] Kim WS, Byeon HK, Park YM, et al.Therapeutic robot-assisted neck dissection via a retroauricular or modified facelift approach in head and neck cancer: a comparative study with conventional transcervical neck dissection[J]. Head Neck, 2015, 37(2): 249-254.
[43] 朱建华, 郭传瑸. 手术机器人系统在颅颌面外科中的应用及发展[J]. 华西口腔医学杂志, 2016, 34(5): 534-538.
Zhu JH, Guo CB.Application and development of surgical robot systems in craniomaxillofacial surgery[J]. West China Journal of Stomatology, 2016, 34(5): 534-538.
[44] de Almeida JR, Li R, Magnuson JS, et al. Oncologic outcomes after transoral robotic surgery: a multi-institutional study[J]. JAMA Otolaryngol Head Neck Surg, 2015, 141(12): 1043-1051.
[45] de Almeida JR, Byrd JK, Wu R, et al. A systematic review of transoral roboticsurgery and radiotherapy for early oropharynx cancer: a systematic review[J]. Laryngoscope, 2014, 124(9): 2096-2102.
[46] Leonhardt FD, Quon H, Abrahão M, et al.Transoral robotic surgery for oropharyngeal carcinoma and its impact on patient-reported quality of life and function[J]. Head Neck, 2012, 34(2): 146-154.
[47] Kelly K, Johnson-Obaseki S, Lumingu J, et al.Oncologic, functional and surgical outcomes of primary transoral robotic surgery for early squamous cell cancer of the oropharynx: a systematic review[J]. Oral Oncol, 2014, 50(8): 696-703.
[48] Nichols AC, Theurer J, Prisman E, et al.Radiotherapy versus transoral robotic surgery and neck dissection for oropharyngeal squamous cell carcinoma (ORATOR): an open-label, phase 2, randomised trial[J]. Lancet Oncol, 2019, 20(10): 1349-1359.
[49] Asher SA, White HN, Kejner AE, et al.Hemorrhage after transoral robotic-assisted surgery[J]. Otolaryngol Head Neck Surg, 2013, 149(1): 112-117.
[50] Schmalbach CE, Miller FR.Occult primary head and neck carcinoma[J]. Curr Oncol Rep, 2007, 9(2): 139-146.
[51] Keller F, Psychogios G, Linke R, et al.Carcinoma of unknown primary in the head and neck: comparison between positron emission tomography (PET) and PET/CT[J]. Head Neck, 2011, 33(11): 1569-1575.
[52] Grewal AS, Rajasekaran K, Cannady SB, et al.Pharyngeal-sparing radiation for head and neck carcinoma of unknown primary following TORS assisted work-up[J]. Laryngoscope, 2020, 130(3): 691-697.
[53] Haas I, Hoffmann TK, Engers R, et al.Diagnostic strategies in cervical carcinoma of an unknown primary (CUP)[J]. Eur Arch Otorhinolaryngol, 2002, 259(6): 325-333.
[54] Davis KS, Byrd JK, Mehta V, et al.Occult primary head and neck squamous cell carcinoma: utility of discovering primary lesions[J]. Otolaryngol Head Neck Surg, 2014, 151(2): 272-278.
[55] Patel SA, Magnuson JS, Holsinger FC, et al.Robotic surgery for primary head and neck squamous cell carcinoma of unknown site[J]. JAMA Otolaryngol Head Neck Surg, 2013, 139(11): 1203-1211.
[56] Fu TS, Foreman A, Goldstein DP, et al.The role of transoral robotic surgery, transoral laser microsurgery, and lingual tonsillectomy in the identification of head and neck squamous cell carcinoma of unknown primary origin: a systematic review[J]. J Otolaryngol Head Neck Surg, 2016, 45(1): 28-38.
[57] Geltzeiler M, Doerfler S, Turner M, et al.Transoral robotic surgery for management of cervical unknown primary squamous cell carcinoma: updates on efficacy, surgical technique and margin status[J]. Oral Oncol, 2017, 66: 9-13.
[58] Zafereo ME, Hanasono MM, Rosenthal DI, et al.The role of salvage surgery in patients with recurrent squamous cell carcinoma of the oropharynx[J]. Cancer, 2009, 115(24): 5723-5733.
[59] Riva G, Cravero E, Briguglio M, et al.The flex robotic system in head and neck surgery: a review[J]. Cancers(Basel), 2022, 14(22): 5541.
[60] Nichols AC, Theurer J, Prisman E, et al.Randomized trial of radiotherapy versus transoral robotic surgery for oropharyngeal squamous cell carcinoma: long-term results of the ORATOR trial[J]. J Clin Oncol, 2022, 40(8): 866-875.