Quality of life of patients treated with robotic surgery in the oral and maxillofacial region: a scoping review of empirical evidence

The screening process had two stages and was based on the above inclusion and exclusion criteria. Titles and abstracts screening was performed in the first stage to exclude all non-relevant literature. In the second stage, the full texts of all those studies that were not excluded in the first stage were evaluated for relevance. Only those studies that met all the inclusion criteria were considered eligible for inclusion in the review. Importantly, each stage of the screening process was performed by two independent reviewers who were dental surgeons (the first stage by KKK and AAS and the second stage by DLB and AAS). In situations of conflicts in the inclusion/exclusion of a study, they were resolved through critical discussions between the reviewers. The full texts of the included literature were shared with senior experts (who are professors and coauthors in this scoping review: RDJ and JA) for their review. Literature was retained when there was consensus between the experts and the initial reviewers. The final consensus document was shared with all authors for further review. Any disagreement on studies to include or exclude was resolved by the involvement of the entire team. No authors or institutions were contacted to identify additional sources.

In terms of country of origin, all studies were from the USA and Europe and the majority were from the USA (n = 12, 66.67%). Others included three from Italy [13, 18, 25], two from the United Kingdom [15, 19] and one from Denmark [30] (Fig. 2). A total of 804 patients were studied in all the reviewed articles with a minimal sample size of 9 participants [29] to a maximum of 138 [20]. The populations mainly varied according to the main pathology and the age groups while in the cohorts of OPC, a significant variation was observed depending on the site of the lesion, human papillomavirus positivity, nodal involvement, and the extent of the lesion.

According to the study design, 10 articles were prospective study designs (55.6%) [14‐16, 18, 21, 22, 24, 28‐30] while seven were retrospective studies [13, 17, 20, 23, 25‐27]. One study was based on a prospective case series [19]. The follow-up periods varied from a one-month postoperative period to a median of 3.8 years.

In total, 20 different instruments were used to assess various aspects of the QOL. Furthermore, some studies used multiple instruments measuring numerous domains. Except in six studies ([13, 15, 17, 20, 21, 23], others used two or more instruments to evaluate the factors that could be related to QOL (Table 2). The most commonly used instrument was the MD Anderson Dysphagia Inventory Questionnaire (MDADI), which evaluates the impact of dysphagia on QOL.

Of the physical, psychological, and social functions assessed in the included articles, physical functions related to swallowing, speech and salivary functions were the most assessed aspects (Table 2). Moreover, in patients with OPC, compared to other common treatment modalities such as chemoradiotherapy, most of the studies reported better outcomes in swallowing functions in patients who underwent TORS [14, 15, 17, 27, 29, 30] (Table 1). It was also noted that speech is minimally affected in TORS procedures [16, 21] (Table 1). Some studies also noted improvement in overall oral functions including taste, speech, saliva functions and eating [20, 26]. However, a significant difference in QOL outcomes was not observed after one year (Table 1). The location of the lesion, the need for unilateral/bilateral neck dissection and adjunctive therapies such as chemoradiation were the main factors affecting QOL (Table 1).

Among those patients who underwent tonsillectomy and tongue base reduction due to hypertrophic tongue, they also demonstrated better functional outcomes and improved QOL with TORS [13, 19, 25] (Table 1).