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Dr John Burke, AXA Health Director of Medical Policy
This document outlines the current AXA Health policy for Head and Neck robot-assisted surgery and is based on NICE guidance, review of the literature and interviews carried out with a number of chairs/committee leads from BAHNO, BAOMS, and ENT UK.
It is clear from this work that transoral robotic surgery (TORS) uptake is variable across Head and Neck networks but that there has been increasing linkage of MDTs so that patients can move centres to access TORS as required.
Overview of Operations and Evidence
Mucosectomy / Unknown Primary Surgery
The evidence is strong that TORS is an optimal approach for cancers of unknown primary. The alternative to this is blind random biopsies and bilateral tonsillectomies which will often not find the primary, resulting in the need for wide radiotherapy fields which carry a significant morbidity. The mucosectomy allows the complete or targeted removal of the mucous membrane at the back of the tongue, confirming the diagnosis and removing the primary cancer. This is reflected in NICE guidelines which support this as an option (https://www.nice.org.uk/guidance/ng36/chapter/recommendations).
- AXA Health policiesi will fully fund these procedures which are widely accepted as safe and lower morbidity for the patient than alternatives.