***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Recent increases in incidence and survival of oropharyngeal cancers in the United States have been attributed to human papillomavirus ( HPV ) infection , but empirical evidence is lacking . PATIENTS AND METHODS HPV status was determined for all 271 oropharyngeal cancers ( 1984 - 2004 ) collected by the three population -based cancer registries in the Surveillance , Epidemiology , and End Results ( SEER ) Residual Tissue Repositories Program by using polymerase chain reaction and genotyping ( Inno-LiPA ) , HPV16 viral load , and HPV16 mRNA expression . Trends in HPV prevalence across four calendar periods were estimated by using logistic regression . Observed HPV prevalence was reweighted to all oropharyngeal cancers within the cancer registries to account for nonr and om selection and to calculate incidence trends . Survival of HPV-positive and HPV-negative patients was compared by using Kaplan-Meier and multivariable Cox regression analyses . RESULTS HPV prevalence in oropharyngeal cancers significantly increased over calendar time regardless of HPV detection assay ( P trend < .05 ) . For example , HPV prevalence by Inno-LiPA  increased from 16.3 % during 1984 to 1989 to 71.7 % during 2000 to 2004 . Median survival was significantly longer for HPV-positive than for HPV-negative patients ( 131 v 20 months ; log-rank P < .001 ; adjusted hazard ratio , 0.31 ; 95 % CI , 0.21 to 0.46 ) . Survival significantly increased across calendar periods for HPV-positive ( P = .003 ) but not for HPV-negative patients ( P = .18 ) . Population -level incidence of HPV-positive oropharyngeal cancers increased by 225 % ( 95 % CI , 208 % to 242 % ) from 1988 to 2004 ( from 0.8 per 100,000 to 2.6 per 100,000 ) , and incidence for HPV-negative cancers declined by 50 % ( 95 % CI , 47 % to 53 % ; from 2.0 per 100,000 to 1.0 per 100,000 ) . If recent incidence trends continue , the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020 . CONCLUSION Increases in the population -level incidence and survival of oropharyngeal cancers in the United States since 1984 are caused by HPV infection OBJECTIVE To design a reliable and vali date d self-administered question naire whose purpose is to assess dysphagia 's effects on the quality of life ( QOL ) of patients with head and neck cancer . DESIGN Cross-sectional survey study . METHODS Focus groups were convened for question naire development and design . The M. D. And erson Dysphagia Inventory ( MDADI ) included global , emotional , functional , and physical subscales . One hundred consecutive adult patients with a neoplasm of the upper aerodigestive tract who underwent evaluation by our Speech Pathology team completed the MDADI and the Medical Outcomes Study 36-Item  Short Form Health Survey  ( SF-36 ) . Speech pathologists completed the Performance Status Scale for each patient . Validity and reliability properties were calculated . Analysis of variance was used to assess how well the MDADI discriminated between groups of patients . RESULTS The internal consistency reliability of the MDADI was calculated using the Cronbach alpha coefficient . The Cronbach alpha coefficients of the MDADI subscales ranged from 0.85 to 0.93 . Test-retest reliability coefficients of the subscales ranged from 0.69 to 0.88 . Spearman correlation coefficients between the MDADI subscales and the SF-36 subscales demonstrated construct validity . Patients with primary tumors of the oral cavity and oropharynx had significantly greater swallowing disability with an adverse impact on their QOL compared with patients with primary tumors of the larynx and hypopharynx ( P<.001 ) . Patients with a malignant lesion also had significantly greater disability than patients with a benign lesion ( P<.001 ) . CONCLUSIONS The MDADI is the first vali date d and reliable self-administered question naire design ed specifically for evaluating the impact of dysphagia on the QOL of patients with head and neck cancer . St and ardized question naires that measure patients ' QOL offer a means for demonstrating treatment impact and improving medical care . The development and validation of the MDADI and its use in prospect i ve clinical trials allow for better underst and ing of the impact of treatment of head and neck cancer on swallowing and of swallowing difficulty on patients ' QOL OBJECTIVE To evaluate changes in patient-perceived swallowing function over time following transoral robotic surgery ( TORS ) for primary T1 and T2 oropharyngeal squamous cell carcinomas . DESIGN Prospect i ve case series . SETTING Academic tertiary referral center . PATIENTS Forty-two patients with T1 or T2 oropharyngeal squamous cell carcinomas . INTERVENTION TORS-assisted resection of indicated tumors . MAIN OUTCOME MEASURES Changes in patient-perceived swallowing function over time ( using the M. D. And erson Dysphagia Inventory ) and gastrostomy tube dependence . RESULTS Between March 19 , 2007 , and April 21 , 2010 , forty-two patients with primary T1 or T2 oropharyngeal squamous cell carcinomas underwent TORS-assisted resection . Most ( 76 % [ 32 of 42 ] ) patients had stage III disease ; 93 % ( 39 of 42 ) of patients underwent staged neck dissection . The median postoperative follow-up time was 17 months ( range , 4 - 40 months ) . There were no complications or tumor recurrences . Postoperative chemotherapy use predicted gastrostomy tube retention for longer than 3 months ( P = .01 ) . Immediate mean postoperative M. D. And erson Dysphagia Inventory scores in each assessed domain ( global , emotional , physical , and functional ) decreased compared with preoperative baseline scores ; however , ongoing improvement in all domains was observed over time . Nodal status ( P = .049 ) , follow-up time of less than 12 months ( P = .03 ) , and preoperative physical scores of less than 100 ( P = .01 ) predicted poorer physical M. D. And erson Dysphagia Inventory outcomes . Positive pathological margins predicted poorer functional scores ( P = .03 ) . CONCLUSIONS After TORS-assisted resection of T1 and T2 oropharyngeal squamous cell carcinomas , approximately one-third of patients will experience a sustained decrease in perceived swallowing function . However , ongoing improvement of swallowing function over time is likely even after 12 months . Patients receiving adjuvant chemotherapy  after TORS should be counseled about the possibility of prolonged gastrostomy tube dependence OBJECTIVE To describe and show the feasibility of a new surgical technique for transoral robotic surgery ( TORS ) radical tonsillectomy .  DESIGN A prospect i ve , phase 1 clinical trial . SETTING Academic , tertiary referral center . PATIENTS A total of 27 participants were prospect ively selected using a volunteer sample . All eligible patients agreed to participate in the study . INTERVENTIONS Patients underwent TORS radical tonsillectomy for previously untreated invasive squamous cell carcinoma of the tonsillar region without free-flap reconstruction , staged neck dissection , and adjuvant therapy . MAIN OUTCOME MEASURES Outcome measures included final pathologic margin status , need for short- and long-term tracheotomy tube placement , and need for gastrostomy tube feedings among patients with a minimum 6-month follow-up . The incidence of significant postoperative complications was recorded . RESULTS No mortality occurred . Final margins found to be negative for cancer were achieved in 25 of 27 patients ( 93 % ) . Surgical complications included 1 case each of postoperative mucosal bleeding , delirium tremens , unplanned tracheotomy for temporary exacerbation of sleep apnea , and hypernasality and 2 cases of moderate trismus . Twenty-six of 27 patients ( 96 % ) were swallowing without the use of a gastrostomy . CONCLUSIONS Radical tonsillectomy using TORS is a new technique that offers excellent access for resection of carcinomas of the tonsil with acceptable acute morbidity . Future reports will focus on long-term oncologic and functional outcomes OBJECTIVES /HYPOTHESIS To investigate the feasibility of transoral robotic surgery as a method of surgical treatment of oropharyngeal squamous cell carcinoma . STUDY DESIGN Prospect i ve case study . METHODS Forty-five patients with previously untreated oropharyngeal squamous cell carcinoma underwent transoral robotic surgical removal of the tumor with or without neck dissection and with or without adjuvant therapy . Patients were observed and data were recorded on surgical time , blood loss , surgical complications , tracheostomy tube course , enteral feeding , and resumption of oral diet , speech outcomes , swallowing outcomes , and tumor recurrence . RESULTS All 45 patients underwent complete transoral robotic surgical excision  with simultaneous unilateral or bilateral neck dissection . Margins were negative for tumor . Mean operating time for tumor removal was 71.3 minutes for the last 35 cases . There were 15 stage T1 tumors , 18 T2 tumors , 3 T3 tumors , and 9 T4a tumors . Twenty-six patients had base of tongue primary tumors and 19 had tonsillar fossa tumors . Fourteen patients had a tracheostomy tube placed at surgery , and all patients had their tracheostomy tube removed ( mean duration of use , 7.0 days ) . Twenty-two patients ( 48.9 % ) had a nasogastric feeding tube placed , and all patients had their feeding tube removed ( mean duration of use , 12.5 days ) . Eight patients had percutaneous gastrostomy ( PEG ) tubes placed , and all eight eventually had their PEG tubes removed ( mean duration of use , 140.3 days ) . Average hospital stay was 3.8 days . There were no major complications and no procedure was aborted because of an inability to remove the tumor . CONCLUSIONS Transoral robotic surgery is a safe and efficacious method of surgical treatment of oropharyngeal neoplasms . Advantages of the technique include adequate ability to visualize and manipulate with two h and s lesions in the base of tongue . Patients were able to retain or rapidly regain oropharyngeal function in the majority of cases OBJECTIVES To determine the oncologic and functional outcomes in patients undergoing primary transoral robotic surgery followed by adjuvant therapy as indicated with a minimum of 18-month follow-up for advanced oropharyngeal carcinoma . DESIGN Prospect i ve single-center cohort study . SETTING Academic university health system and tertiary referral center . PATIENTS Forty-seven adults with newly diagnosed and previously untreated advanced oropharyngeal carcinoma . INTERVENTION Transoral robotic surgery with staged neck dissection and adjuvant therapy as indicated . MAIN OUTCOME MEASURES Margin status , recurrence , disease-specific and disease-free survival , gastrostomy tube dependence , and safety and efficacy end points . RESULTS In the 47 patients enrolled with stages III and IV advanced oropharyngeal carcinoma , mean follow-up was 26.6 months . There was no intraoperative or postoperative mortality . Resection margins were positive in 1 patient ( 2 % ) . At last follow-up , local recurrence was identified in 1 patient ( 2 % ) , regional recurrence in 2 ( 4 % ) , and distant recurrence in 4 ( 9 % ) . Disease-specific survival was 98 % ( 45 of 46 patients ) at 1 year and 90 % ( 27 of 30 patients ) at 2 years . Based on pathologic risk stratification , 18 of 47 patients ( 38 % ) avoided chemotherapy , and 5 patients ( 11 % ) did not receive adjuvant radiotherapy and concurrent chemotherapy in their treatment regimen . At minimum follow-up of 1 year , only 1 patient required a gastrostomy tube . CONCLUSIONS This novel transoral robotic surgery treatment regimen offers disease control , survival , and safety commensurate with st and ard treatments and an unexpected beneficial outcome of gastrostomy dependency rates that are markedly lower than those reported with st and ard nonsurgical therapies BACKGROUND The aim of this study was to assess the quality of life of patients with oropharyngeal squamous cell carcinoma after transoral robotic surgery ( TORS ) .  METHODS Short Form (SF)-8 and Performance Status Scale ( PSS ) question naires were completed prior to surgery , 6 and 12 months of follow-up . RESULTS In all , 38 patients treated with TORS followed by adjuvant therapy as indicated were prospect ively enrolled . For PSS Eating and Diet domains , significant decreases occurred at 6 months ( p ≤ .001 
    Output:
    
Feeding tube rates were the most commonly reported functional outcome .
Crude end points of functional recovery after TORS ± adjuvant therapy suggest promising swallowing outcomes , depending on the functional measure reported