Transoral robotic surgery for advanced oropharyngeal carcinoma

Objectives: To determine the oncologic and functional outcomes in patients undergoing primary transoral robotic surgery followed by adjuvant therapy as indicated with a minimum of 18-month follow-up for advanced oropharyngeal carcinoma. Design: Prospective single-center cohort study. Setting: Academic university health system and tertiary referral center. Patients: Forty-seven adults with newly diagnosed and previously untreated advanced oropharyngeal carcinoma. Intervention: Transoral robotic surgery with staged neck dissection and adjuvant therapy as indicated. Main Outcome Measures: Margin status, recurrence, disease-specific and disease-free survival, gastrostomy tube dependence, and safety and efficacy end points. Results: In the 47 patients enrolled with stages III and IV advanced oropharyngeal carcinoma, mean follow-up was 26.6 months. There was no intraoperative or postoperative mortality. Resection margins were positive in 1 patient (2%). Atlast follow-up, local recurrence was identified in 1 patient (2%), regional recurrence in 2 (4%), and distant recurrence in 4 (9%). Disease-specific survival was 98% (45 of 46 patients) at 1 year and 90% (27 of 30 patients) at 2 years. Based on pathologic risk stratification, 18 of 47 patients (38%) avoided chemotherapy, and 5 patients (11%) did not receive adjuvant radiotherapy and concurrent chemotherapy in their treatment regimen. At minimum follow-up of 1 year, only 1 patient required a gastrostomy tube. Conclusions: This novel transoral robotic surgery treatment regimen offers disease control, survival, and safety commensurate with standard treatments and an unexpected beneficial outcome of gastrostomy dependency rates that are markedly lower than those reported with standard nonsurgical therapies.