Patienten-Benefit und Lebensqualität nach Roboter-assistierten Operationen im Kopf-Hals-Bereich

Zusammenfassung

Robotische Systeme für den Einsatz bei Operationen im Kopf-Hals-Bereich befinden sich in unterschiedlichen Stadien der technischen Entwicklung und der klinischen Anwendung. Vorrangig kommen robotische Systeme bei transoralen Operationen im Bereich des Pharynx und Larynx zum Einsatz, erste Erkenntnisse liegen jedoch auch zu onkologischen und funktionellen Ergebnissen nach Roboter-assistierten Operationen an den Halsweichteilen, der Schilddrüse und im Bereich des Mittel- und Innenohrs vor. Das folgende Referat bietet einen Überblick über die Anwendungsbereiche der Roboter-assistierten Chirurgie im Kopf-Hals-Bereich im Hinblick auf den potenziellen Patienten-Benefit und die post-operative Lebensqualität. Der Schwerpunkt liegt dabei auf der Rolle der transoralen robotischen Chirurgie (TORS) bei der Resektion von Oropharynxkarzinomen. Für diesen Anwendungsbereich liegen umfangreiche und langfristige Erkenntnisse vor, welche funktionelle Vorteile für ausgewählte Oropharynxkarzinom-Patienten nach TORS im Vergleich zu Therapiealternativen wie der offenen Chirurgie und der primären Strahlentherapie zeigen. Da der TORS auch eine wichtige Rolle im Hinblick auf eine mögliche Therapiedeeskalation für HPV-positive Oropharynxkarzinom-Patienten zukommt, werden entsprechende laufende Studien vorgestellt. Bei der Beurteilung des Therapie-Benefits und der Lebensqualität ist insbesondere bei Tumorpatienten zu beachten, dass individuelle Patienten-Präferenzen deutlich variieren können. Beeinflussende Faktoren und Tools zur detaillierten Erfassung von Lebensqualitätsparametern werden daher zu Beginn des Referats erläutert.

Während einige robotische Systeme für den Einsatz in der Ohrchirurgie und Schädelbasischirurgie in Europa entwickelt und angewandt werden, kommen TORS-Systeme derzeit vor allem in Nordamerika und Asien zum Einsatz. Dies liegt darin begründet, dass in Europa und vor allem Deutschland mit der transoralen Laser-Mikrochirurgie (TLM) seit Jahrzenten eine bewährte Technologie für die transorale Tumorresektion zur Verfügung steht. Zukünftige Studien zum Vergleich von TORS und TLM mit einer detaillierten Erfassung von Lebensqualitätsparametern könnten dazu beitragen, geeignete Anwendungsbereiche für die jeweilige Technologie zu identifizieren.

Schlüsselwörter

Lebensqualität - Transorale robotische Chirurgie (TORS) - Oropharynxkarzinome - Therapiedeeskalation

Publication History

Article published online:
23 May 2022

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