Transoral robotic surgery in head and neck cancer: an umbrella review of meta-analyses

BACKGROUND: The aim of this umbrella review is to investigate the advantages of primary transoral robotic surgery (TORS) over other treatments such as open surgery (OS), transoral laser microsurgery (TLM) and primary radiotherapy in the diagnosis management of head and neck cancer (HNC). MATERIALS AND METHODS: A comprehensive search for meta-analyses of comparisons between TORS of HNC and other treatments such as OS, TLM and primary radiotherapy was conducted in the PubMed, Embase, and Cochrane library databases. The primary outcomes assessed include oncological outcomes, surgical outcomes, function outcomes and complicates. The AMSTAR-2 tool was used to assess the quality, which consists of 16 entries, with final quality outcomes categorized as "critically low quality," "low quality," "moderate quality," and "high quality." RESULTS: Of the 1424 articles retrieved, 14 studies were eventually included for the comprehensive umbrella meta-analysis. TORS was superior to OS in terms of survival rate, length of hospital stay, cosmetic outcome, quality of life, surgical efficacy, and recognition of HNC with unknown primary lesion, but no significant difference was seen between them and TLM or radiation therapy. CONCLUSION: There are few studies on head and neck tumors other than oropharyngeal cancer, and there is a lack of studies on specific tumor stages or HPV status of the population, which does not allow for the provision of personalized treatment recommendations based on the patient's own situation, and there is a need to carry out more randomized controlled trials on the specific type and status of the patient in future.