Robotic Surgery as Monotherapy for HPV Positive Oropharyngeal Cancer

Abstract

Objective: Describe the oncologic results achievable when treating oropharyngeal squamous cell carcinoma (OPSCC) with transoral robotic surgery (TORS) and neck dissection as monotherapy. Evaluate the patient selection, functional outcomes, morbidity, and cost of this treatment option.

Method: Data was collected prospectively on patients undergoing TORS and neck dissection for OPSCC from April 2007-present. Patients treated with surgery alone and a minimum 18-month follow-up were included in the study. Primary outcomes include disease control, survival, HPV status, and tracheostomy and G-tube rate.

Results: During the study period 90 patients underwent TORS for OPSCC and 18 were treated with surgery alone due to favorable tumor findings or refusal of adjuvant therapy. Sixty-eight percent of tumors were HPV positive. Stage distribution included; 7 stage I, 5 stage II, 3 stage III, and 3 stage IVa. Mean follow-up was 27 months. Complete disease control and disease-specific survival was achieved in 83% and 94% of patients, respectively. Among HPV-positive patients, 100% survival and 90% disease control were achieved. No patients required long-term tracheostomy or G-tube placement.

Conclusion: TORS is an effective modality for treating select OPSCC. Low complication rates and excellent functional outcomes were achieved with TORS.