The need to take ≥2 margins to achieve resection portends an increased risk of locoregional recurrence and death due to disease in oropharyngeal SCC.

Transoral robotic surgery is emerging as a primary treatment modality for oropharyngeal malignancies. Neck dissection is a required portion of operative therapy in many of these patients, and many surgeons delay neck dissection to prevent pharyngocutaneous fistula. Pharyngeal communication with the neck is a common occurrence during transoral surgery when it is combined concurrently with neck dissection, but persistent fistula formation is an uncommon, preventable, but potentially problematic, complication resulting from this operative technique. Prompt recognition and intervention are of paramount importance in preventing acute, long-term functional impairment.

Transoral surgery is an effective approach for the treatment of HPV-related oropharyngeal carcinoma. The addition of adjuvant therapy appears to decrease the risk of recurrence and improve disease-free survival but may not significantly improve overall survival.

4. Laryngoscope, 127:623-630, 2017.