A Meta‐analysis of Functional Outcomes and Recovery Metrics Comparing Transoral Robotic Surgery and (Chemo)Radiotherapy

Objective To assess patient outcomes with regard to swallowing, feeding tube dependence, tracheostomy use, pain levels, and recovery metrics between transoral robotic surgery and (chemo)radiotherapy. Data Sources Medline, EMBASE, Web of Science Core Collection, and the Cochrane Library. Review Methods A meta‐analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines through a literature search of data sources (CRD42023464144). Results Sixteen studies comprising 2185 patients were included. There were no significant differences in sex and age distribution between the transoral robotic surgery and (chemo)radiotherapy groups. Most patient demographics and disease status at baseline were comparable between the two groups. Meta‐analysis of the studies found reduced gastrostomy tube usage in the transoral robotic surgery group at 6 and 12 months albeit poorer swallowing outcomes at 12 months according to the MD Anderson Dysphagia Index. Pain levels were generally lower in the transoral robotic surgery group in the long term. Conclusion This review presents the most extensive examination to date of swallowing performance and recovery metrics in controlled trials of transoral robotic surgery versus (chemo)radiotherapy. Our findings show that transoral robotic surgery shows promise in managing difficult anatomical areas and low‐grade tumors. However, methodological inconsistencies were noted between included studies, particularly in eligibility criteria and human papillomavirus p16 status. Consensus statements and/or guidelines on stratification and reporting of patients may aid in reducing this heterogeneity, while further randomized controlled trials may improve our understanding and guide the development of clinical guidelines on treatment choice.