TORS Use in Early Stage Oropharyngeal Cancer May Lower Positive Margin Outcome

What are the long-term oncologic outcomes and adjuvant therapies for patients treated with transoral robotic surgery (TORS), nonrobotic surgery, or transoral laser microsurgery (TLM)?

Bottom Line
The advantages of TORS for early stage OPSCC may be a lower likelihood of postsurgical positive margins and subsequent need for adjuvant chemoradiotherapy.

Background: TORS was approved by FDA in December 2009 for oropharyngeal squamous cell carcinoma (OPSCC) treatment. Understanding whether TORS helps facilitate negative margins is important in understanding its clinical impact in OPSCC management. TLM, another minimally invasive promising surgical technique for oropharyngeal cancers, may be effective at obtaining negative margins and maintaining survival, even in advanced stage cancers.

Study design: Retrospective analysis of patients (2,224 TORS; 6,697 nonrobotic surgery; 333 TLM) with clinical tumor (T)1 and T2 OPSCC.

Setting: National Cancer Database, a joint project of the Commission on Cancer and the American Cancer Society.

Synopsis: TORS patients were more likely to have nodal (N)1 to N3 disease and poorly differentiated tumors than nonrobotic surgery and TLM patients. The TLM cohort had the most patients with basaloid squamous cell carcinoma. The mean hospital length of stay (LOS) was significantly longer for TORS patients; when excluding same-day surgeries, however, TORS patients had a shorter LOS. A total of 83.5% of TORS, 71.6% of nonrobotic surgery, and 78.6% of TLM patients had negative margins. Upon multivariate stepwise logistical regression, TORS was associated with a lower likelihood and similar likelihood of positive margins compared to nonrobotic surgery and TLM, respectively. Among the three surgical modalities, TORS had the lowest proportion of patients receiving an RT dosage of 6,500 to 7,000 cGy in patients with a positive surgical margin, and was associated with lower likelihood of requiring chemotherapy and radiation (CRT). Limitations included missing variables for known OPSCC risk factors (i.e., alcohol and tobacco), and the retrospective study focus on overall survival rather than cancer-specific survival.

Citation: Li H, Torabi SJ, Park HS, et al. Clinical value of transoral robotic surgery: nationwide results from the first 5 years of adoption. Laryngoscope. 2019;129:1844–1855.