Comparison of margins and survival between transoral robotic surgery (TORS) and non-robotic endoscopic surgery for oropharyngeal cancer.

TitleComparison of margins and survival between transoral robotic surgery (TORS) and non-robotic endoscopic surgery for oropharyngeal cancer.
Publication TypeJournal Article
Year of Publication2023
AuthorsGroysman M, Gleadhill C, Baker A, Wang SJ, Bearelly S
JournalAm J Otolaryngol
Date Published2023 Nov-Dec
KeywordsCarcinoma, Squamous Cell, Chemoradiotherapy, Adjuvant, Head and Neck Neoplasms, Humans, Neoplasm Staging, Oropharyngeal Neoplasms, Retrospective Studies, Robotic Surgical Procedures, Squamous Cell Carcinoma of Head and Neck

OBJECTIVE: To evaluate the impact of transoral robotic surgery (TORS) and non-robotic transoral endoscopic surgery on margin positivity, rates of adjuvant therapy and survival in early stage oropharyngeal squamous cell carcinoma.

STUDY DESIGN: Retrospective cohort review.

SUBJECTS AND METHODS: The National Cancer Database was queried to form a cohort of patients with T1-T2 N0-N1 MO oropharyngeal squamous cell carcinoma who underwent TORS or Non-robotic endoscopic surgery from 2010 to 2015. Demographics, disease characteristics and rate of positive margin and adjuvant therapy were summarized. A binary logistic regression and a cox-proportional hazard model were performed to evaluate patient demographic, disease, and treatment factors that could predict margin positivity and survival respectively.

RESULTS: 1026 patients received TORS treatment while 734 patients received non-robotic endoscopic primary surgery. Non-robotic surgery was more likely to have residual tumor (31.6 % of all cases) compared to TORS procedures (13.6 % of TORS cases); p < .0001. Non-robotic surgery more frequently had non-evaluable margins at 8.1 % compared to only 1.4 % of TORS cases (p < .0001). Non-robotic cases had a significantly higher proportion of patients receiving adjuvant radiotherapy and systemic therapy compared to TORS (66.4 % vs 51.3 % for radiotherapy; p < .0001 and 33.4 % vs 22.2 % for chemotherapy; p < .0001). There was no difference in mortality between the two modalities (non-robotic vs TORS, HR 1.357, 95 % CI 0.937-1.967).

CONCLUSION: TORS and non-robotic surgery may have a similar impact on survival in early-stage OPSCC, but non-robotic surgery was found to have a higher likelihood of positive margins and a higher rate of adjuvant chemoradiation therapy.

Alternate JournalAm J Otolaryngol
PubMed ID37531886
Faculty Reference: 
Audrey Baker, MD, FACS
Shethal Bearelly, MD, FACS
Steven J. Wang, MD