Transoral Robotic versus Open Surgical Approaches to Oropharyngeal Squamous Cell Carcinoma by Human Papillomavirus Status

Abstract

Objectives: 1) Investigate oncologic survival outcomes. 2) Analyze the impact of human papillomavirus (HPV) status on prognosis in patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with transoral robotic (TORS) vs. open surgery. Methods: Retrospective case-control study of 130 total patients treated for primary OPSCC with either TORS or open surgery and appropriate adjuvant therapy between October 2004 and March 2012 at the University of Alabama at Birmingham Hospital (tertiary care referral center). Cases and controls were matched based on TNM staging. Recurrence-free survival was used to evaluate the impact of human papillomavirus-mediated carcinogenesis and surgical intervention on prognosis. Kaplan-Meier, chi-square, and t-test analyses were used. Results: Patients treated with transoral robotic surgery survived more frequently (94% and 89% at 1 and 3 years, respectively) than for those treated with open surgery (85% and 72% at 1 and 3 years, correspondingly) (Breslow P = 0.035). Patients with HPV-positive cancers treated with either TORS or open approaches and patients with HPV-negative tumors treated with TORS all survived at similar rates. Patients with HPV-negative OPSCCs treated with open surgical approaches, however, survived without recurrence less frequently at 1 and 3 year rates of 58% and 25%, respectively ( P = 0.001 and 0.001 vs. HPV-positive TORS, respectively; P = 0.008 and 0.001 vs. HPV-positive non-TORS, respectively). Conclusions: These data suggest that TORS is at least equivalent to, if not better than, open surgical approaches to OPSCC in providing recurrence-free survival at one- and three-year post-operative intervals to patients regardless of HPV status.