“Close Then Clear” Margins in Transoral Resection of p16+ Oropharyngeal Squamous Cell Carcinoma

Objective Standard 5‐mm surgical margins in the oropharynx are challenging due to the intimate relationship with neurovascular structures and patient function. De‐escalation of therapy with the acceptance of close surgical margins may improve functional patient outcomes. This study assesses locoregional recurrence with initial close (≤2 mm) margins following transoral surgery for p16+ oropharyngeal squamous cell carcinoma (SCC) with or without re‐resection and adjuvant therapy. Study Design Retrospective cohort study. Setting Canadian tertiary care center. Methods Retrospective chart review of all patients who underwent transoral robotic surgery or transoral laser microsurgery with curative intent for p16+ oropharyngeal SCC and had ≤2 mm initial surgical margins with or without re‐resection and adjuvant therapy between January 2019 and December 2023. The primary outcome was 2‐year locoregional control. Results In total, 80 patients were included; 54 had a 2‐year follow‐up available. Initial margins were close (≤2 mm) in 44 patients (55%) and positive in 34 patients (42.5%). Re‐resection was performed in 67 patients (83.8%). Following re‐resections, three patients (3.8%) had positive margins and 77 (96.2%) had close or clear margins. Deep margins were most involved (67.5%). In total, 42 patients (52.5%) received adjuvant (chemo)‐radiotherapy. Amongst the 54 patients eligible for 2‐year follow‐up, one had regional recurrence at 18 months postsurgery, resulting in a 2‐year locoregional control rate of 98.1%. Conclusion p16+ oropharyngeal SCC with close initial surgical margins results in low locoregional recurrence rates. Intraoperative re‐resection with acceptance of close surgical margins may be an effective strategy to preserve both oncologic safety and functional outcomes.