The Role of Transoral Robotic Surgery in the Management of HPV Negative Oropharyngeal Squamous Cell Carcinoma

Abstract

The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is on the rise. This is largely due to the rapid increase in HPV positive OPSCC, which has been shown to confer a survival advantage. HPV negative OPSCC, however, has a more aggressive tumor biology and is a challenge to treat with standard current therapies. Chemoradiation has demonstrated poor locoregional control in HPV negative OPSCC, and open surgeries are associated with high morbidity. Transoral robotic surgery (TORS) has been proposed as an option to both intensify treatment and decrease surgical morbidity for patients with HPV negative OPSCC. TORS can be utilized as a primary treatment or in persistent, recurrent, or second primary OPSCC. There is emerging data showing improved functional outcomes with TORS versus open surgery or chemoradiation. Unfortunately, there have been no randomized trials comparing TORS to chemoradiation in HPV negative OPSCC. This article will review utility of TORS for HPV negative OPSCC.

Transoral robotic surgery for oropharyngeal squamous cell carcinoma in the era of human papillomavirus

“…Although deintensification is warranted in patients with HPV-positive oropharyngeal SCC with survival rates exceeding 90%, the opposite is true for HPV-negative oropharyngeal SCC, in which intensification may improve the poor prognosis seen in this group. 36 The evidence supporting a treatment paradigm in this select patient population is scarce and relies mostly on small retrospective analyses or subgroup analyses of prospective studies which, in either case, are plagued by the limited sample size of the HPV-negative patient population. 5,21,37,38 For instance, the 2-year survival ranged from 31%-74% in studies using nonsurgical approaches, 5,21 whereas it was 80%-94% in TORS-based studies.…”

Survival benefit of surgical approach for advanced oropharyngeal and hypopharyngeal cancer: A retrospective analysis

“…Therefore, we argue that definitive surgery be recommended more often for the non‐HPV‐related patient population with poor prognosis because of its potential to increase survival. Robotic surgery was previously proposed for patients with HPV‐negative advanced oropharyngeal cancer in order to improve survival and to reduce surgery‐induced functional impairment …”

“…Robotic surgery was previously proposed for patients with HPV-negative advanced oropharyngeal cancer in order to improve survival and to reduce surgery-induced functional impairment. 36 For hypopharyngeal cancer, there has similarly been a steady decline in the use of open surgery 37,38 because of the increasing attempts to preserve speech and swallowing function. However, organ-conserving CRT entails significant adverse effects as surgery, with a large number of patients remaining gastrostomy tube-dependent and tracheotomydependent.…”

Transoral Robotic Surgery for Oropharyngeal Cancer

“…A few prospective series have identified that adding surgery to the treatment for patients with HPV-negative cancers offers better control rates [22]. As discussed above, the morbidity and mortality rates attributed to open surgery [1] do not apply to surgical practices in the current day, and especially to transoral surgery; data on 30-day mortality from the UK national head and neck database indicates a mortality of < 1% [23].…”