title: Transoral Robotic Surgery: A Population-Level Analysis.
abstract: (1) To determine baseline demographic, geographic, clinical, and pathologic characteristics of patients who had transoral robotic surgery (TORS) for oropharyngeal cancer. (2) To analyze margin status and unplanned readmission after TORS versus nonrobotic surgery.
  
  
  
  Retrospective database review.
  
  
  
  National Cancer Database (2010-2011).
  
  
  
  Searching the National Cancer Database for adults with oropharyngeal cancer, we identified 877 patients who had TORS and 4269 patients who had nonrobotic surgery. Outcomes of interest included likelihood of adjuvant therapy, margin status, and unplanned readmission. Statistical analysis included chi-square, t tests, and multivariate regression.
  
  
  
  From 2010 to 2011, there was a 67% increase in the use of TORS for oropharyngeal cancer. Compared with patients who had nonrobotic surgery, TORS patients were more likely to be at academic centers (80.8% vs 49.1%, P < .001), to have private insurance (62.2% vs 57.4%, P < .001), and to have human papilloma virus (HPV)-positive tumors (48.3% vs 27.1%, P < .001). TORS (odds ratio, 0.50; 95% CI, 0.39-0.63) and HPV positivity (odds ratio, 0.73; 95% CI, 0.53-0.99) were independently associated with decreased likelihood of adjuvant chemoradiation versus radiation therapy. TORS patients were less likely to have positive margins than were patients who had nonrobotic surgery (20.2% vs 31.0%, P < .001). High-volume TORS centers had lower rates of positive margins (15.8% vs 26.1%, P < .001) and unplanned readmissions (3.1% vs 6.1%, P < .03) than did low-volume centers.
  
  
  
  TORS is being rapidly adopted by academic and community cancer centers. TORS is associated with a lower rate of positive margins than nonrobotic surgery, and high-volume centers have the lowest rates of positive margins and unplanned readmissions.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Chen
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.affiliation: The Center for Head and Neck Oncology, New York Head and Neck Institute, Northshore Health System, New York, New York, USA.
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Kraus
authors.affiliation: Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA benjamin.judson@yale.edu.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Judson
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: National Cancer Data Base; adjuvant therapy; margins; oropharyngeal cancer; transoral robotic surgery; unplanned readmission