Background:
Transoral robotic surgery (TORS) is a well-established and minimally invasive alternative primary therapy to standard Radiation therapy for early-stage oropharyngeal squamous cell carcinoma (OPSCC). TORS has been associated with equivalent oncologic control and purported to have potentially improved functional, and quality of life outcomes. However, treatment effects such as dysphagia remain commonly reported and a subset of patients continue on to receive adjuvant therapy.

Objective:
: The primary objective was to examine patient-reported decisional regret following TORS. Secondary objectives included identifying variables associated with patient-reported regret, dysphagia, and quality of life.

Methods: A cross-sectional survey was administered to 76 patients treated with TORS for early stage OPSCC from February 2016 to August 2021. Patients completed the validated Decision Regret Scale (DRS), MD Anderson Dysphagia Inventory (MDADI), and University of Washington Quality of Life (UW-QoL). Univariate and multivariate analyses were conducted with patient-reported outcomes and clinical data.

Results: A total of 65 (86%) patients completed the survey, with mean age 62, 78.5% male, of which 46% received TORS alone, 40% adjuvant radiation and 14% chemoradiation. 13.8% of patients expressed moderate to high regret following primary surgery. Decisional regret was highly correlated with postoperative dysphagia (τ_avg=0.361, p<0.001), and limitations on social and personal life were the strongest driver of decisional regret (p<0.001, τ= 0.481). Univariate analysis showed that clinical (p=0.03, τ=0.26) and pathological N stage (p=0.04, τ =0.20) were predictors of decision regret. Charlson Comorbidity Index (CCI) was a predictor of both dysphagia (p=0.007, τ=0.05) and postoperative quality of life (p=0.001, τ=0.07). The number of positive lymph nodes was a predictor of both postoperative quality of life (p=0.03, τ = 0.17) and decisional regret (p=0.02, τ = 0.04). The primary tumour size, as determined by PET-CT imaging, was a predictor of quality of life (p=0.02, τ = 0.05). Both univariate and multivariate analyses showed no statistical difference in sex, smoking history, primary oropharyngeal site, lymphovascular or perineural invasion, or adjuvant therapy in predicting postoperative decisional regret, dysphagia, or quality of life.

Conclusions: This is the largest study to examine patient-reported regret, dysphagia, and quality of life after TORS for OPSCC. Nodal pathology and preoperative comorbidities accurately predict decisional regret, dysphagia, and quality of life in OPSCC patients. The administration of adjuvant treatment of OPSCC in this cohort did not significantly affect patients’ decision regret, perceived quality of life or functional outcomes.