Long-term swallowing outcomes following transoral robotic surgery for oropharyngeal cancer - Five years and beyond.

OBJECTIVE

Transoral robotic surgery (TORS), either used alone or combined with radiotherapy, is a common treatment for operable T-stage oropharyngeal squamous cell carcinoma (OPSCC). Due to high survival rates, maintaining quality of life-especially swallowing function-is an important long-term consideration. This study aimed to assess swallowing outcomes five years and beyond following TORS in patients with primary OPSCC.

METHODS

"Functional outcome swallowing scale" (FOSS) was used to retrospectively assess long-term dysphagia in 47 OPSCC patients, with a median follow-up of 6.8 years. All patients had a minimum follow-up of five years.

RESULTS

The FOSS scores remained stable at five years compared to 1-4 years post-TORS (all p > 0.99). Furthermore, there were no significant differences in FOSS from 1 to 10 years post-TORS compared to preoperative score. Adjuvant therapy was a univariate predictor of worse swallowing outcomes (OR: 17.46, 95% CrI: 2.94-121.51); however, this effect was limited to the short-term postoperative period (≤ 2 years after TORS). In contrast, subsequent major surgery after TORS and treatment of more advanced tumors (pT2-pT3 vs. pTis-pT1) were associated with persistently worse swallowing outcomes, including long-term follow-up (OR: 23.81, 95% CrI: 4.48-142.59; OR: 15.03, 95% CrI: 3.06-81.45, respectively).

CONCLUSIONS

TORS offers excellent and stable long-term swallowing outcomes when used as a single-modality treatment for OPSCC. While outcomes remain satisfactory with additional therapies, swallowing results are influenced by tumor stage, adjuvant treatment, and further major surgery.