Transoral robotic surgery for human papillomavirus-positive oropharyngeal squamous cell carcinoma: a retrospective observational study from a UK tertiary centre.

BACKGROUND

Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC) has favourable oncological outcomes, supporting the use of transoral robotic surgery with risk-adapted adjuvant therapy. While anticipated adjuvant treatment intensity is informed by pre-operative assessment, definitive post-operative histopathology determines final risk stratification.

METHODS

A single-centre study was conducted at University College London Hospitals of 44 HPV-positive oropharyngeal SCC patients treated with primary transoral robotic surgery and selective neck dissection. Discrepancies between clinical and pathological staging, and their impact on adjuvant treatment recommendations, were assessed.

RESULTS

Staging discrepancies were identified in 38 per cent of patients. Pathological nodal upstaging occurred in 20.5 per cent of patients, commonly caused by higher-than-anticipated nodal burden. Involved surgical margins were present in 70.5 per cent of patients. Overall, definitive histopathology resulted in escalation of anticipated adjuvant treatment intensity in 61 per cent of patients, with 52 per cent reclassified as high-risk disease.

CONCLUSION

Post-operative histopathology frequently altered anticipated risk stratification, highlighting the limitations of pre-operative staging and the clinical impact of a surgical-first approach.