title: Transoral robotic versus open surgical approaches to oropharyngeal squamous cell carcinoma by human papillomavirus status.
abstract: OBJECTIVE
  (1) Investigate oncologic survival outcomes and (2) analyze the impact of human papillomavirus status on prognosis in patients with oropharyngeal squamous cell carcinoma treated with transoral robotic versus open surgery.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary care referral center, University of Alabama at Birmingham Hospital.
  
  
  METHODS
  One hundred thirty total (65 per treatment arm) with primary oropharyngeal squamous cell carcinoma (OPSCC).
  
  
  METHODS
  Patients treated for primary oropharyngeal squamous cell carcinoma with either transoral robotic (TORS) or open surgery plus standard of care adjuvant therapy between October 2004 and March 2012 were matched based on TNM staging before a retrospective chart review was performed. Carcinoma tissue was stained both prospectively and retrospectively with CINtec p16-INK4a kits for surrogate human papillomavirus typing. Recurrence-free survival was used to evaluate the impact of human papillomavirus tumor status and method of surgical intervention on prognosis.
  
  
  RESULTS
  As a whole, patients treated with transoral robotic surgery survived more frequently (94%, 91%, 89% at 1, 2, 3 years, respectively) than those treated with open surgery (85%, 75%, 73% at 1, 2, 3 years, correspondingly) (P = .035). The subgroup of patients with human papillomavirus-negative malignancies treated with open surgery survived without recurrence less frequently at 1, 2, and 3 year rates of 58%, 25%, 25%, respectively (P < .01).
  
  
  CONCLUSIONS
  These retrospective data suggest that oncologic outcomes are not being sacrificed when patients with OPSCC are treated with TORS instead of open surgery regardless of tumor human papillomavirus immunohistochemical staining.
authors: University of Alabama School of Medicine, Birmingham, Alabama, USA.
authors: Samuel E
authors: SE
authors: Ford
authors: Department of Surgical Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors: Margaret
authors: M
authors: Brandwein-Gensler
authors: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors: William R
authors: WR
authors: Carroll
authors: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors: Eben L
authors: EL
authors: Rosenthal
authors: Head and Neck Surgery Center of Florida, Florida Hospital Celebration Health, Celebration, Florida, USA scott.magnuson@flhospital.org.
authors: J Scott
authors: JS
authors: Magnuson
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery* / Q000821:virology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology*; D027383:Papillomaviridae / Q000302:isolation & purification*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome
keywords: HPV; TORS; carcinoma; human papillomavirus; oropharynx; p16; p16-INK4a; robotic; surgery; survival; transoral