Investigating the impact of margins on the management of oropharyngeal cancer treated with transoral robotic surgery: a survey of head and neck oncologists’ treatment patterns

BACKGROUND: There remains heterogeneity in the management of intermediate-risk factors following transoral robotic surgery (TORS) for oropharyngeal cancer (OPC). METHODS: A 23-item case-based survey assessing postoperative-management across risk factors following TORS for OPC was distributed to members of the American Head and Neck Society (AHNS). RESULTS: Sixty-four responses (4.5 % of members) were received, predominantly from U.S-based surgical oncologists (96.2 %), with most reporting ≥ 10 years in practice. Without additional pathological risk factors, observation was recommended for 98.4 % of cases with > 5 mm and 3 mm margins, decreasing to 79.7 % for 2 mm margins and 48.8 % for 1 mm margins. Positive deep margins prompted adjuvant therapy in 85.9 % of responses; however, when re-resection achieved negative margins, adjuvant treatment decreased to 20.3 %. For clear margins with four positive nodes and no extranodal extension, most respondents recommended adjuvant radiation to the neck alone (48.4 %). CONCLUSIONS: Adjuvant therapy decisions following TORS should involve multidisciplinary discussion including consideration of re-resection.