Transoral robotic surgery-based therapy for HPV-related oropharyngeal squamous cell carcinoma

Abstract

Background: Transoral robotic surgery (TORS) for the treatment of early human papillomavirus-related oropharyngeal squamous cell carcinoma (HPVOPSCC) is a well-established treatment modality. It requires a distinctive skill set from the head and neck surgeon to achieve optimal oncological and functional outcomes. The aim of this study is to demonstrate oncological outcomes of HPVOPSCC treated with TORS and guideline indicated adjuvant therapy. Methods: A consecutive case series of adult patients with HPVOPSCC undergoing primary surgical treatment by a single fellowship trained robotic head and neck surgeon in Australia was performed. Adjuvant therapy (radiotherapy with or without chemotherapy) was delivered based on current guidelines. The primary outcomes were to determine complete resection of the primary tumour, locoregional recurrence, disease specific survival, and overall survival. The secondary outcomes were to determine complications; post-operative haemorrhage, salivary leak, and need for percutaneous gastrostomy (PEG) insertion. Results: A total of 41 patients were assessed. Adjuvant therapy was indicated in 15 (36.6%) patients (radiotherapy: 14; chemoradiotherapy: 1). The follow-up was 51 [interquartile range (IQR) 24] months. The positive margin rate on histopathology analysis was 4.9% (n=2). The locoregional recurrence rate was 4.9% (n=2). The disease-specific survival and overall survival rate was 100% at 3 years, and 95.1% at 5 years. TORS-related complications occurred in 5 patients (12.1%), of which 2 patients (4.9%) had a secondary haemorrhage, 1 patient (2.4%) had a salivary leak, and 2 patients (4.9%) required short-term PEG insertion. Conclusions: TORS for the treatment of early stage HPVOPSCC can result in complete resection, low rates of recurrence, and acceptable complication profile.