Transoral robotic surgery for oropharyngeal carcinoma: Surgical margins and oncologic outcomes

BACKGROUND: This study presents oncologic outcomes after transoral robotic surgery (TORS) ± adjuvant therapy for oropharyngeal squamous cell carcinoma (SCC). METHODS: Three hundred fourteen patients undergoing TORS ± adjuvant therapy for oropharyngeal SCC from May 1, 2007, to May 31, 2015, are analyzed. RESULTS: Median follow-up was 3.3 years (interquartile range [IQR] 1.8-5.3 years; range 1 day to 9.3 years). Estimated locoregional recurrence-free survival, distant metastasis-free survival (DMFS), overall survival (OS), and cancer-specific survival (CSS) rates (95% confidence interval [CI] number still at risk) at 5 years after surgery were 92% (88-95; 92), 90% (86-94; 92), 86% (82-92; 98), and 94% (91-97; 98), respectively. Negative margins were achieved in 98% of cases. The adult comorbidity evaluation (ACE)-27 comorbidity index, human papillomavirus (HPV) status, pathologic N classification, and number of attempts to clear margins were associated with death due to cancer (P = .003, P = .002, P = .030, and P = .002, respectively). CONCLUSION: The need to take ≥2 margins to achieve resection portends an increased risk of locoregional recurrence and death due to disease in oropharyngeal SCC.