Oncologic outcomes of transoral robotic surgery for HPV‐negative oropharyngeal carcinomas

Abstract

Background Patients with human papillomavirus (HPV)‐negative oropharyngeal squamous cell carcinoma (OPSCC) continue to experience disappointing outcomes following chemoradiotherapy (CRT) and appreciable morbidity following historical surgical approaches. We aimed to investigate the oncologic outcomes and perioperative morbidity of a transoral robotic surgery (TORS) approach to surgically resectable HPV‐negative OPSCC. Methods Retrospective analysis HPV‐negative OPSCC patients who underwent TORS, neck dissection and pathology‐guided adjuvant therapy (2005–2017). Results Fifty‐six patients (91.1% stage III/IV) were included. Three‐year overall survival, locoregional control, and disease‐free survival were 85.5%, 84.4%, and 73.6%, respectively (median follow‐up 30.6 months, interquartile range 18.4–66.6). Eighteen (32.1%) patients underwent adjuvant radiotherapy and 20 (39.3%) underwent adjuvant CRT. Perioperative mortality occurred in one (1.8%) patient and hemorrhage occurred in two (3.6%) patients. Long‐term gastrostomy and tracheostomy rates were 5.4% and 0.0%, respectively. Conclusion The TORS approach for resectable HPV‐negative OPSCC can achieve encouraging oncologic outcomes with infrequent morbidity.

Analysis of T1‐T2 stage oropharyngeal squamous cell carcinoma treated with transoral robotic surgery

“…Reports showed that HPVnegative OPSCCs located at the base of the tongue are more likely to have positive surgical margins in TORS. 14,37 However, in our 58 HPVnegative patients, tonsillar tumors stood a higher proportion, which might explain a low rate of positive margin in our data. Together, these suggest that TORS achieves satisfactory R0 resection in patients with T1-T2 stage OPSCC and postoperative complications are controllable.…”

Transoral robotic surgery with neck dissection versus nonsurgical treatment in stage I and II human papillomavirus‐negative oropharyngeal cancer

“…Negative surgical margins were obtained in 80.4% of patients. Crude swallowing outcomes were favorable as well 23 . Only 5.4% of patients required a gastrostomy tube at 1 year, 23.2% received a gastrostomy tube perioperatively or during adjuvant therapy 23 .…”

“…23 Only 5.4% of patients required a gastrostomy tube at 1 year, 23.2% received a gastrostomy tube perioperatively or during adjuvant therapy. 23 These results come in contrast to earlier work in the pre-TORS era demonstrating comparable oncologic outcomes between surgically based treatment versus radiation therapy based treatment, with more severe or fatal complications occurring in surgically treated patients. 3,24 As a consequence, this established radiation therapy as the dominant treatment modality at most centers.…”

“…Results from institutional series are limited by small sample size given the changing epidemiologic trends of OPC, but mirror national data. 16,17,23 In the largest single institution review of 56 patients with T1-T4N0-N2c HPVnegative OPC, Parhar et al reported a 3-year OS and locoregional control rate of 85.5% and 84.4%, respectively. 23 Negative surgical margins were obtained in 80.4% of patients.…”

“…16,17,23 In the largest single institution review of 56 patients with T1-T4N0-N2c HPVnegative OPC, Parhar et al reported a 3-year OS and locoregional control rate of 85.5% and 84.4%, respectively. 23 Negative surgical margins were obtained in 80.4% of patients. Crude swallowing outcomes were favorable as well.…”