The impact of transoral robotic surgery on the overall treatment of oropharyngeal cancer patients.
OBJECTIVES/HYPOTHESIS
To assess adjuvant therapy in patients undergoing surgical management of oropharyngeal squamous cell carcinoma (OPSCCA) with transoral robotic surgery (TORS) and neck dissection.


STUDY DESIGN
A prospective, nonrandomized, consecutive patient series from two separate protocols in a tertiary academic medical center.


METHODS
Patients undergoing treatment for OPSCCA were selected from a prospective protocol evaluating functional and oncologic outcomes following TORS with a comparator group of OPSCCA patients receiving definitive chemoradiotherapy (CRT) participating in a separate prospective protocol.


RESULTS
Forty-two patients represented the TORS group and 38 the CRT group. Twenty (48%) of the TORS patients received surgery only, whereas nine (21%) underwent adjuvant radiotherapy and 13 (31%) adjuvant CRT. Adjuvant therapy patients had a higher overall T (P =.0007) and N (P < .0001) stage than the TORS-only group. Surgery resulted in stage changes in 18 (43%) patients, leading to alteration in therapy for nine (21%) patients. The 3-year overall survival (OS), disease-specific survival (DSS), and locoregional control was 74% versus 90% (P = .30), 94% versus 94% (P = .91), and 72% versus 91% (P = .19) for the TORS-alone versus TORS plus adjuvant therapy groups, respectively. Comparison with the CRT group revealed a survival benefit in the TORS group approaching significance, with a 3-year OS of 83% versus 57% (P = .06) and DSS of 94% versus 85% (P = .08), respectively.


CONCLUSIONS
Primary surgical management of OPSCCA with TORS and neck dissection provides accurate staging information, which can lead to the appropriate selection of subsequent therapy. This approach does not compromise survival and warrants additional investigation.


LEVEL OF EVIDENCE
3b.