Objective: Primary surgical therapy was once the chosen modality to treat oropharyngeal cancer (OPC). However due to its association with high morbidity, radiotherapy with concurrent chemotherapy supplanted it. Trans-oral robotic surgery (TORS) offers a minimally invasive approach to resect OPC with better disease free and complication outcomes when compared to open surgery. These outcomes however are confounded by the treatment of most patients with adjuvant chemotherapy/radiation. This study is a preliminary outcomes report of a single surgeon’s experience with TORS as a primary and single modality in the treatment of OPC.

Methods: A prospectively collected database of OPC patients treated with primary and single modality TORS from 2010 till present was queried. Patients were stratified based on compliance with Head and Neck Tumor Board (TB) recommendations for adjuvant treatment, as well as p16 status. We compared event free survival (i.e. no local/regional recurrence, metastases, death) and overall survival in relation to these two factors. However, as this is a preliminary study with a small number of patients, significance testing comparing the two groups was not possible.

Results: A total of 20 patients with primary OPC managed with only TORS were included, 80% were male, 80% were Caucasian and the average age was 64 years. The average follow up was 3.03 years. 89% of patients presented with early stage cancer (T1,T2). Fourteen patients followed TB recommendations and 6 did not. The average age (65 vs. 64 years), smoking rate >10 pack years (61.5% vs. 66.7%),p16 + status (69.2% vs. 66.7%) and follow up (3.18 vs 2.67 years) were comparable between the two groups. The group that did not follow TB recs had a higher percentage of late stage cancer (100% vs. 46.2%) and a higher proportion of African Americans (33.3% vs. 7.7%). The event free survival rate for those that did not follow TB recommendations was 50% (3/6) compared to 78.6% in those that did (11/14). Among the patients that did follow TB recommendations, 11 had p16+ cancer, with an event free survival of 72.7% (8/11) compared to 67% (2/3) in patients with p16- cancer. In patients that did not follow TB recommendations, 4 had p16+ cancer, with an event free survival of 75% (3/4) compared to 0% (0/2) in patients with p16- cancer.

Conclusion:: The use of TORS as a single and primary modality offers a minimally invasive approach in the management of OPC. This study is a preliminary study with a small number of patients that demonstrated satisfactory outcomes in early stage cancer. Patients who did not follow TB recommendations had demonstrably poorer outcomes, especially p16 negative OPC with the caveat of small sample size limiting significance of the findings. Future research will focus on obtaining multi-site data to evaluate outcomes of TORS as a single and primary modality for the treatment of early stage OPC in p16 positive OPC. These results may be crucial for developing treatment guidelines for early stage OPC.