Publication:

The utility of transoral robotic surgery for oropharyngeal squamous cell carcinoma: functional and perioperative outcomes

Background To evaluate the functional recovery, oncologic and perioperative outcomes of patients undergoing transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC).

Methods A retrospective cohort study of 103 patients who underwent TORS between 2015 and 2024 was conducted. Patients were stratified into diagnostic-TORS (patients with head and neck cancer of unknown primary origin (HNCUP), n=28) and therapeutic-TORS groups (resection of T1-T2 OPSCC, n=75). The primary outcomes were oropharyngeal function post-TORS. Secondary outcomes related to HNCUP detection, treatment de-intensification, overall survival (OS), and surgical complications.

Results Immediate oral intake was observed in 90.3% of patients. No patients required long-term gastrostomy feeding. A progressive improvement in diet and fluid levels was observed, with 88.9% of patients achieving a normal diet within 12 months. At 12 months post-TORS, 90.3% of patients recovered their premorbid speech level. HNCUP identification rate was 42.9% with diagnostic-TORS. Five-year OS was 89% (95% CI, 78-94%). Tumours with positive p16 status had significantly improved OS (94% vs. 63%, p=0.001). Although margin status did not demonstrate statistically significant differences in OS (p=0.313), all patients requiring re-excision achieved clear margins, facilitating treatment de-intensification. Post-operative bleeding was observed in 6.8% of patients, with a peri-operative mortality rate of 1.9%.

Conclusions TORS is effective in oropharyngeal cancer management, delivering excellent functional and survival outcomes. Our study supports the role of TORS in treatment de-intensification. The risk of significant haemorrhagic complications necessitates rigorous perioperative protocols.