Abstract
Background. Transoral robotic surgery (TORS) is an emerging treatment option for the treatment of head and neck malignancies, particularly for oropharyngeal squamous cell carcinoma (OPSCC). Preliminary studies have demonstrated excellent oncologic and functional outcomes that have led to a resurgence of interest in the primary surgical management of OPSCC. The aim of the present study was to review the evidence base supporting the use of TORS in OPSCC. Methods. Studies evaluating the application of TORS in the treatment of head and neck squamous cell carcinoma (HNSCC), and more specifically OPSCC, were identified for review. Further searches were made of reference lists for complete evaluation of minimally invasive surgery (MIS) in treating OPSCC. Results. Seventeen results relating to the application of TORS in treatment of OPSCC were identified. Further results relating to the role of transoral laser microsurgery (TLM) in OPSCC were included for review. Feasibility, oncologic, and functional data is summarized and discussed. Discussion. Management strategies for patients with OPSCC continue to evolve. Minimally invasive surgical techniques including TORS and TLM offer impressive functional and oncologic outcomes particularly for patients with early T-classification and low-volume regional metastatic disease. Potential exists for treatment deintensification, particularly in patients who are HPV positive.
Highlights
500,000 new cases of head and neck squamous cell carcinoma (HNSCC) are diagnosed each year making HNSCC the 6th most common cancer worldwide [1]
The rate of HNSCC has been increasing recently secondary to an epidemic of human papillomavirus- (HPV-) related oropharyngeal squamous cell cancer (OPSCC)
The aim of the current review is to provide an evaluation of the existing literature with regards to the oncologic and functional outcomes following treatment of oropharyngeal squamous cell carcinoma (OPSCC) with minimally invasive surgery and in particular, Transoral robotic surgery (TORS)
Summary
500,000 new cases of head and neck squamous cell carcinoma (HNSCC) are diagnosed each year making HNSCC the 6th most common cancer worldwide [1]. The rate of HNSCC has been increasing recently secondary to an epidemic of human papillomavirus- (HPV-) related oropharyngeal squamous cell cancer (OPSCC). A randomized controlled trial of primary radiation versus surgery for oropharyngeal cancer has not been carried out, several retrospective analyses have demonstrated less major complications and improved functional outcomes with radiation compared to traditional primary surgical approaches. These results have contributed to the widespread adoption of primary nonsurgical treatment in patients with OPSCC. Studies evaluating the application of TORS in the treatment of head and neck squamous cell carcinoma (HNSCC), and OPSCC, were identified for review. Potential exists for treatment deintensification, in patients who are HPV positive
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