Purpose
The advent of minimally invasive transoral robotic surgery (TORS) has changed the role of surgery in the multimodal approach to treatment of oropharyngeal squamous cell carcinoma (OPSCC). Current literature suggests that in early OPSCC, TORS and radiotherapy as single modalities have comparable oncological results. However, there is a relative paucity of research investigating differences in morbidity between these modalities.
Methodology
A multi-centre retrospective cohort study of patients at two tertiary Head & Neck cancer centres. Patients with primary OPSCC, clinical stage of T1-2 and up to 1 clinical cervical metastatic lymph node (N0-1) that underwent TORS were included. All subjects underwent initial staging neck dissection where pathological staging was established based on the American Joint Committee on Cancer Cancer Staging (AJCC 8th Ed). Patients with pN0-1 cervical lymph node were treated definitively with TORS as a single-modality. Those with positive TORS margins or multiple LN’s received adjunctive radiotherapy (PORT) or chemoradiotherapy (CRT). Patients were followed postoperatively for 25 months on average. Outcomes related to postoperative feeding, overall survival and recurrence free survival were studied.
Results
Ninety-six patients were included in the study (N=96). Of these, 56 received single modality TORS (smTORS), 26 adjuvant PORT (aPORT), and 14 adjuvant CRT (aCRT). Both overall survival and recurrence free survival was 96% in the smTORS and aPORT groups, and 93% in the aCRT group. A pre-morbid (normal) diet was achieved postoperatively in 95% of smTORS and aPORT subjects, and 78% of aCRT subjects. One case within the aPORT group required a PEG tube for feeding (4%).
Conclusion
TORS as a single modality treatment for selected primary OPSCC cases has shown excellent survival outcomes and may potentially yield improved functional outcomes in the short and long-term in comparison with multimodality treatment for these tumours.