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A Comprehensive Analysis of Socio-economic and Clinical Factors in Head and Neck Cancer Patients Receiving Robotic Surgery

Published online by Cambridge University Press:  24 July 2025

Darby Keirns ,
Beau Hsia Open the ORCID record for Beau Hsia [Opens in a new window] ,
Paula Valeria Guerra-Navarro ,
Xinxin Wu ,
Peter Silberstein ,
James Reed Gardner  and
Vijay Patel
Darby Keirns
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
Beau Hsia*
Affiliation:
Creighton University School of Medicine, Phoenix, AZ, USA
Paula Valeria Guerra-Navarro
Affiliation:
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
Xinxin Wu
Affiliation:
School of Medicine, Creighton University, Omaha, NV, USA
Peter Silberstein
Affiliation:
Department of Medicine, Hematology and Oncology, School of Medicine, Creighton University, Omaha, NV, USA
James Reed Gardner
Affiliation:
Department of Otolaryngology–Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Vijay Patel
Affiliation:
Division of Pediatric Otolaryngology, Rady Children’s Hospital, San Diego, CA, USA
*
Corresponding author: Beau Hsia; Email: beauhsiacreighton@gmail.com
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Abstract

Objectives

To investigate socio-economic and clinical disparities in the utilisation of robotic surgery for head and neck cancer.

Methods

Using the National Cancer Database (2010–2020), 212 449 surgically treated patients were analysed. Multivariate logistic regression identified predictors of robotic versus non-robotic surgery (p < 0.05).

Results

Robotic surgery utilisation increased over time during the study period. The following characteristics positively correlated with the use of robotic surgery: male, aged 41–80 years, White race, insured (with private insurance, Medicaid and Medicare) and treatment at an Academic/Research centre. Metropolitan residency, higher income/education levels, lower comorbidity (Charlson–Deyo score of 0) and Stage I disease were also associated with increased robotic surgery utilisation.

Conclusion

Significant socio-economic disparities exist in robotic surgery access, potentially exacerbating outcome inequities. Targeted interventions are needed to improve equity in treatment access and standardise care protocols. Further research should validate trends and address systemic barriers.

Keywords

RoboticsHead and Neck NeoplasmsOtorhinolaryngologic Surgical ProceduresNasopharyngeal NeoplasmsParotid Neoplasms

Information

Type
Main Article
Information
The Journal of Laryngology & Otology , First View , pp. 1 - 8
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

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Footnotes

Presented as an oral presentation at the AAO-HNSF 2023 Annual Meeting & OTO Experience in Nashville, Tennessee on 3 October, 2023.

References

Siegel, RL, Miller, KD, Fuchs, HE, Jemal, A. Cancer statistics, 2021. CA Cancer J Clin 2021;71:7–33Google Scholar
Mella, MH, Chabrillac, E, Dupret-Bories, A, Mirallie, M, Vergez, S. Transoral robotic surgery for head and neck cancer: advances and residual knowledge gaps. J Clin Med 2023;12:2303Google Scholar
Garg, A, Dwivedi, RC, Sayed, S, Katna, R, Komorowski, A, Pathak, KA, et al. Robotic surgery in head and neck cancer: a review. Oral Oncol 2010;46:571–6Google Scholar
Chia, SH, Gross, ND, Richmon, JD. Surgeon experience and complications with transoral robotic surgery (TORS). Otolaryngol Head Neck Surg 2013;149:885–92Google Scholar
Boudreaux, BA, Rosenthal, EL, Magnuson, JS, Newman, JR, Desmond, RA, Clemons, L, et al. Robot-assisted surgery for upper aerodigestive tract neoplasms. Arch Otolaryngol Head Neck Surg 2009;135:397–401Google Scholar
Hockstein, NG, O’Malley, BW, Weinstein, GS. Assessment of intraoperative safety in transoral robotic surgery. Laryngoscope 2006;116:165–8Google Scholar
Weinstein, GS, O’Malley, BW, Snyder, W, Hockstein, NG. Transoral robotic surgery: supraglottic partial laryngectomy. Ann Otol Rhinol Laryngol 2007;116:19–23Google Scholar
O’Malley, BW, Weinstein, GS, Snyder, W, Hockstein, NG. Transoral robotic surgery (TORS) for base of tongue neoplasms. Laryngoscope 2006;116:1465–72Google Scholar
Garas, G, Arora, A. Robotic head and neck surgery: history, technical evolution and the future. ORL J Otorhinolaryngol Relat Spec 2018;80:117–24Google Scholar
Weinstein, GS, O’Malley, BW, Desai, SC, Quon, H. Transoral robotic surgery: does the end justify the means? Curr Opin Otolaryngol Head Neck Surg 2009;17:126–31Google Scholar
Moore, EJ, Olsen, KD, Kasperbauer, JL. Transoral robotic surgery for oropharyngeal squamous cell carcinoma: a prospective study of feasibility and functional outcomes. Laryngoscope 2009;119:2156–64Google Scholar
White, HN. Learning curve for transoral robotic surgery: a 4-year analysis. JAMA Otolaryngol Head Neck Surg 2013;139:564–7Google Scholar
Albergotti, WG, Gooding, WE, Kubik, MW, Geltzeiler, M, Kim, S, Duvvuri, U, et al. Assessment of surgical learning curves in transoral robotic surgery for squamous cell carcinoma of the oropharynx. JAMA Otolaryngol Head Neck Surg 2017;143:542–8Google Scholar
Chen, AY, Fedewa, S, Pavluck, A, Ward, EM. Improved survival is associated with treatment at high-volume teaching facilities for patients with advanced stage laryngeal cancer. Cancer 2010;116:4744–52Google Scholar
Shin, JY, Truong, MT. Racial disparities in laryngeal cancer treatment and outcome: a population-based analysis of 24,069 patients. Laryngoscope 2015;125:1667–74Google Scholar
O’Keefe, EB, Meltzer, JP, Bethea, TN. Health disparities and cancer: racial disparities in cancer mortality in the United States, 2000–2010. Front Public Health 2015;3:51Google Scholar
Bradley, CJ, Given, CW, Roberts, C. Disparities in cancer diagnosis and survival. Cancer 2001;91:178–88Google Scholar
Ellis, L, Canchola, AJ, Spiegel, D, Ladabaum, U, Haile, R, Gomez, SL. Racial and ethnic disparities in cancer survival: the contribution of tumor, sociodemographic, institutional, and neighborhood characteristics. J Clin Oncol 2018;36:25–33Google Scholar
Morris, AM, Rhoads, KF, Stain, SC, Birkmeyer, JD. Understanding racial disparities in cancer treatment and outcomes. J Am Coll Surg 2010;211:105–13Google Scholar
Abdel-Rahman, O, North, S. Socioeconomic disparities in the prevalence of comorbid chronic conditions among Canadian adults with cancer. Acta Oncol 2022;61:294–301Google Scholar
Graboyes, EM, Ellis, MA, Li, H, Kaczmar, JM, Sharma, AK, Lentsch, EJ, et al. Racial and ethnic disparities in travel for head and neck cancer treatment and the impact of travel distance on survival. Cancer 2018;124:3181–91Google Scholar
Bilimoria, KY, Stewart, AK, Winchester, DP, Ko, CY. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 2008;15:683–90Google Scholar
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–83Google Scholar
Sheetz, KH, Claflin, J, Dimick, JB. Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open 2020;3:e1918911Google Scholar
Aloisi, A, Tseng, JH, Sandadi, S, Callery, R, Feinberg, J, Kuhn, T, et al. Is robotic-assisted surgery safe in the elderly population? An analysis of gynecologic procedures in patients ≥65 years old. Ann Surg Oncol 2019;26:244–51Google Scholar
Ceccarelli, G, Andolfi, E, Biancafarina, A, Rocca, A, Amato, M, Milone, M, et al. Robot-assisted surgery in elderly and very elderly population: our experience in oncologic and general surgery with literature review. Aging Clin Exp Res 2017;29:55–63Google Scholar
Vaidya, V, Partha, G, Karmakar, M. Gender differences in utilization of preventive care services in the United States. J Womens Health 2012;21:140–5Google Scholar
Courtenay, WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med 2000;50:1385–401Google Scholar
Dittberner, A, Friedl, B, Wittig, A, Buentzel, J, Kaftan, H, Boeger, D, et al. Gender disparities in epidemiology, treatment, and outcome for head and neck cancer in Germany: a population-based long-term analysis from 1996 to 2016 of the Thuringian cancer registry. Cancers (Basel) 2020;12:3418Google Scholar
McDermott, H, Choudhury, N, Lewin-Runacres, M, Aemn, I, Moss, E. Gender differences in understanding and acceptance of robot-assisted surgery. J Robot Surg 2020;14:227–32Google Scholar
Frenkel, CH, Yang, J, Zhang, M, Regenbogen, E, Telem, DA, Samara, GJ. Trends and the utilization of transoral robotic surgery with neck dissection in New York State. Laryngoscope 2017;127:1571–6Google Scholar
Mao, J, Genkinger, JM, Rundle, AG, Wright, JD, Aryal, S, Liebeskind, AY, et al. Racial and ethnic disparities in the use of robot-assisted surgery and minimally invasive surgery in pelvic cancer treatment: a systematic review. Cancer Epidemiol Biomarkers Prev 2024;33:20–32Google Scholar
Liu, JC, Egleston, BL, Blackman, E, Ragin, C. Racial survival disparities in head and neck cancer clinical trials. J Natl Cancer Inst 2023;115:288–94Google Scholar
Ng, AP, Sanaiha, Y, Bakhtiyar, SS, Ebrahimian, S, Branche, C, Benharash, P. National analysis of cost disparities in robotic-assisted versus laparoscopic abdominal operations. Surgery 2023;173:1340–5Google Scholar
Haggstrom, DA, Lee, JL, Dickinson, SL, Kianersi, S, Roberts, JL, Teal, E, et al. Rural and urban differences in the adoption of new health information and medical technologies. J Rural Health 2019;35:144–54Google Scholar
Niewinski, P, Golusiński, W. Current indications and patient selection for transoral robotic surgery in head and neck cancer: a brief review. Współczesna Onkol 2022;26:91–6Google Scholar
De Almeida, JR, Li, R, Magnuson, JS, Smith, RV, Moore, E, Lawson, G, et al. Oncologic outcomes after transoral robotic surgery: a multi-institutional study. JAMA Otolaryngol Head Neck Surg 2015;141:1043–8Google Scholar
Palma, DA. National Cancer Data Base: an important research tool, but not population-based. J Clin Oncol 2017;35:571Google Scholar
Mohanty, S, Bilimoria, KY. Comparing national cancer registries: the National Cancer Data Base (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) program. J Surg Oncol 2014;109:629–30Google Scholar