Transoral Surgery Alone for Human-Papillomavirus–Associated Oropharyngeal Squamous Cell Carcinoma

Abstract

The aim of this retrospective study was to describe the oncologic and functional results of treating oropharyngeal squamous cell carcinoma with transoral robotic surgery and neck dissection as monotherapy. A review was performed, including all patients who underwent transoral robotic surgery and neck dissection as the only means of therapy for oropharyngeal carcinoma from March 2007 to July 2009 at a single tertiary care academic medical center. We reviewed all cases with ≥ 24-month follow-up. Functional outcomes included tracheostomy dependence and oral feeding ability. Oncologic outcomes were stratified by human papillomavirus (HPV) status and tobacco use and included local, regional, and distant disease control, as well as disease-specific and recurrence-free survival. Eighteen patients met study criteria. Ten patients (55.6%) were able to eat orally in the immediate postoperative period, and 8 (44.4%) required a temporary nasogastric tube for a mean duration of 13.6 days (range 3 to 24 days) before returning to an oral diet. No patient required placement of a gastrostomy tube, and all patients are tracheostomy-tube–free. Among the HPV-positive nonsmokers (12/18, 66.7%), Kaplan-Meier estimated 3-year local, regional, and distant control rates were 90.9%, 100%, and 100%, respectively. Kaplan-Meier estimated disease-specific survival and recurrence-free survival were 100% and 90.9%, respectively. No complications occurred.

Outcomes of relapsed human papillomavirus‐related oropharyngeal squamous cell carcinoma treated with curative intent

“…Despite most patients doing well, up to 25% of patients relapse in their disease in the first 3 years, most frequently as a LRR. 4,5,8,9,22 DM occur slightly less frequently in 2%-12%. 4,5,22,23 Our rates of LRR and DM after TOS AE adjuvant therapy compare well to these studies with 7.4% and 6.3%, respectively.…”

“…4,5 It is also more responsive to treatment and some series report survival rates above 90%. [6][7][8][9] Given the high degree of treatment-related morbidity after standard management for oropharyngeal cancer, multiple studies are currently underway to investigate deescalation of therapy in pursuit of decreasing long-and short-term treatment-related sequelae while still maintaining the same rate of disease control. 10 Although, most patients have a favorable prognosis, a subset of patients relapses in their disease.…”

“…10 Although, most patients have a favorable prognosis, a subset of patients relapses in their disease. Loco-regional recurrence (LRR) has been reported to occur in 4%-23% 6,7,9,11 whereas distant metastasis (DM) occur in 2%-22%. 9,12,13 Traditionally, recurrent OPSCC has been associated with poor survival.…”

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

“…It has been well-established that HPV positivity is a favorable prognostic indicator for patients with oropharyngeal cancer, 12 and prior studies have shown this to be true for patients treated with transoral techniques as well. 7,26 Our study is the first single TORS cohort to demonstrate a statistically significant difference in survival between HPV-positive and HPV-negative patients. These findings suggest that HPV status may be helpful in designing a tailored therapy for patients.…”

“…In our cohort, HPV status was even more important than nodal staging, which is consistent with previous findings. 26 This single-institution study is limited by small sample size and limited length of follow-up. Multi-institutional TORS studies are underway and will add more robust data to the TORS literature.…”