Trismus, defined as restricted mouth opening, is a common complication among Taiwanese oral cancer patients, especially those who chew betel quid. However, the impact of trismus on survival outcomes in oral cancer patients undergoing transoral robotic surgery (TORS) is unclear. This study aimed to investigate the associations between trismus and surgical outcomes in Taiwanese male oral cancer patients treated with TORS. We conducted a retrospective propensity score-matched cohort study of 40 Taiwanese male oral cancer patients who underwent TORS between 2016 and 2022. Overall, 20 patients with trismus were matched to 20 patients without trismus. TORS achieved similar operative and short-term clinical outcomes in trismus patients to non-trismus patients. There were no significant differences between groups in operation time, blood loss, margin status, flap reconstruction rates, duration of nasogastric tube feeding, or length of hospital stay. Kaplan–Meier and Cox proportional hazard regression analyses were performed to compare overall survival (OS) and disease-free survival (DFS) between the two groups. The overall survival (OS) rate at three years was significantly lower in patients with trismus than those without trismus (27.1% vs. 95.0%, log-rankp= 0.02). However, there was no significant difference in disease-free survival (DFS) rates between the trismus and non-trismus groups (36.6% vs. 62.7%, log-rankp= 0.87). After adjusting for confounders, trismus was independently associated with a 13-fold increased risk of mortality (adjusted HR 12.87, 95% CI 1.55–106.50,p< 0.05). In conclusion, trismus appears to be an independent prognostic factor for reduced long-term OS in Taiwanese male oral cancer patients undergoing TORS, though short-term surgical outcomes were non-inferior in the trismus patients. Further research is warranted to clarify the mechanisms linking trismus and survival in this population.
张口受限是台湾口腔癌患者常见的并发症，尤以咀嚼槟榔者为甚。然而，张口受限对接受经口机器人手术的口腔癌患者生存结局的影响尚不明确。本研究旨在探讨台湾男性口腔癌患者接受经口机器人手术治疗时，张口受限与手术结局的关联性。我们开展了一项回顾性倾向评分匹配队列研究，纳入2016年至2022年间接受经口机器人手术的40例台湾男性口腔癌患者。最终将20例张口受限患者与20例无张口受限患者进行匹配。结果显示，张口受限患者与非张口受限患者在经口机器人手术的术中及短期临床结局方面表现相似。两组在手术时间、出血量、切缘状态、皮瓣重建率、鼻饲管留置时间及住院时长等方面均无显著差异。通过Kaplan-Meier法和Cox比例风险回归模型比较两组总生存期和无病生存期，发现张口受限患者三年总生存率显著低于非张口受限患者（27.1% vs. 95.0%，时序检验p=0.02），但两组无病生存率无显著差异（36.6% vs. 62.7%，时序检验p=0.87）。校正混杂因素后，张口受限与死亡风险增加13倍独立相关（校正后风险比12.87，95%置信区间1.55–106.50，p<0.05）。综上所述，尽管张口受限患者的短期手术结局不劣于非受限患者，但张口受限可能是影响台湾男性口腔癌患者经口机器人手术后长期总生存率降低的独立预后因素。未来需进一步研究阐明张口受限影响该人群生存的机制。
Transoral Robotic Surgery for Oral Cancer: Evaluating Surgical Outcomes in the Presence of Trismus
肿瘤(癌症)患者之家