The Role for Surgical Management of HPV-Related Oropharyngeal Carcinoma

Abstract

Human papillomavirus (HPV)-associated oropharyngeal carcinoma has become the predominate cause of oropharyngeal carcinoma in the United States and Europe. Management of this disease is controversial. Traditional open surgical techniques gave way to concurrent chemoradiotherapy following several American and European organ-preservation trials suggesting that both modalities were equally efficacious. More recently, minimally invasive surgical techniques have gained popularity. These techniques provide an opportunity to achieve a complete surgical resection without the treatment-related morbidity associated with open surgery. Proponents of this technique contend that transoral surgical techniques provide a means to analyze the tumor tissue, prognosticate, and personally direct therapy. Skeptics suggest that HPVassociated oropharyngeal carcinoma responds well to chemoradiotherapy and that surgery may not provide a treatment advantage. Both approaches provide a unique perspective and both are currently being studied under trial.

Decision management in transoral robotic surgery: Indications, individual patient selection, and role in the multidisciplinary treatment for head and neck cancer from a European perspective

“…In many centers, this evidence has led to the development of a dogma that most, if not all, patients with potentially curable HPV‐driven oropharyngeal SCC should be managed with first‐line CRT. However, this dogma ignores increasing evidence that surgery for HPV‐driven tumors offers equivalent, if not improved, survival benefits . Currently, there is no evidence to support the first‐line use of CRT over surgery for patients with T1 to T2 HPV‐driven tumors .…”

Transoral Robotic Surgery for Oropharyngeal Cancer

“…16 The technique improves visualization and adds degrees of freedom to surgical movements. Complication rates are low 17 and swallowing function remains high. 8, 17, 18 Initial, limited HRQOL data has shown that speech, eating, social and overall QOL domains tend to decrease from baseline, but remain high at 3 months post-TORS.…”

“…Complication rates are low 17 and swallowing function remains high. 8, 17, 18 Initial, limited HRQOL data has shown that speech, eating, social and overall QOL domains tend to decrease from baseline, but remain high at 3 months post-TORS. 18 However, long term results with significant patient numbers are lacking.…”

Impact of human papillomavirus and smoking on survival outcomes after transoral robotic surgery

“…TORS provides an alternative treatment option for oropharyngeal SCC. Although techniques, such as transoral laser microsurgery, have been used for decades, TORS has a favorable learning curve and provides technical advantages, such as increased degrees of freedom with the instruments . Surgery provides valuable pathologic information that can be used to guide adjuvant therapy .…”