Oncological Outcomes of Transoral Robotic Surgery and Neck Dissection Without Adjuvant Therapy in Patients With Low-, Intermediate-, and High-Risk Pathological Features in Oropharyngeal Carcinoma-An Institutional Experience.

IMPORTANCE

Pathologic risk features after transoral robotic surgery (TORS) inform the need for adjuvant therapy in oropharyngeal cancer (OPC); however, traditional risk stratification criteria may not fully apply to oropharyngeal carcinoma treated with TORS, especially for HPV+ disease.

OBJECTIVES

The purpose of this study was to determine oncological outcomes including disease-free survival and overall survival in patients with intermediate-risk and high-risk histopathological features who underwent TORS without adjuvant radiation therapy.

DESIGN

We conducted a cohort study of patients with OPC, with intermediate-risk and high-risk pathological features who underwent primary TORS with neck dissection and without adjuvant treatment between 2015 and 2023 at the Princess Margaret Care Centre in Toronto, Canada.

SETTING/

PARTICIPANTS

Adult patients with a diagnosis of oropharyngeal carcinoma treated at the Princess Margaret Cancer Center/University Health Network between January 2015 and December 2023 were included in the study.

INTERVENTION: Transoral robotic surgical removal of primary oropharyngeal carcinoma with concurrent neck dissection.

MAIN OUTCOME MEASURES: Oncologic outcomes assessed included local, regional, and distant recurrence along with disease-free survival (DFS) and overall survival (OS).

RESULTS

Forty-two patients (27 male: 15 female; median age = 58) with 43 primary oropharyngeal cancers were included, of whom 33 (79%) were p16 positive. At a median follow-up of 49 months, 41 patients (98%) remained disease-free. Three patients (7%) developed second primaries in different sites that were successfully salvaged.

CONCLUSIONS

Patients with OPC treated with TORS alone have favorable oncologic outcomes, although second primary tumors remain a risk, likely related to field cancerization or multifocality.

RELEVANCE: Overall survival and locoregional control do not appear to be compromised in patients with OPSCC and adverse intermediate-to-high-risk features on histopathology who do not proceed to adjuvant therapy.