A single centre analysis of outcomes and patterns of failure in head and neck cancer patients treated with single modality transoral robotic surgery

Background: Due to the evolving aetiology of human papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma (OPSCC), there has been a trend towards de-escalation in treatment. Our study investigates the oncological safety of head and neck cancer patients undergoing transoral robotic surgery (TORS) +/− neck dissection (ND) as a single modality in a unique Adelaide cohort. Methods: Retrospective, single-centre, observational study on head and neck squamous cell carcinoma patients treated with TORS +/− ND without adjuvant treatment from 2013 to 2021. Primary outcome measures were overall survival, disease-free survival. The secondary outcome of interest was patterns of recurrence of medical/surgical complications. Results: A total of 55 patients were identified in the study period with median (interquartile range) follow up of 34.0 (18.0–47.5) months. estimated 2-year disease-free survival and overall survival of 91.6% and 98.2% respectively. There were 10 recurrences in 6 (10.9%) patients of which, 8 were locoregional and 2 were distant metastases. Recurrences were salvaged with radical chemoradiotherapy/radiotherapy in four patients, and further resection in one patient. Five patients received palliative management. The rate of major inpatient complications (Clavien-Dindo III–IV) was 12.7%, including 4 (7.3%) secondary haemorrhages requiring return to theatre. Conclusions: Single-modality surgery appears to be a safe oncological treatment for early-stage head and neck squamous cell carcinoma in select cases with favourable pathological characteristics. Loco-regional recurrence was the most common treatment failure and can often be salvaged with further surgery or chemoradiotherapy.