title: The impact of transoral robotic surgery on the overall treatment of oropharyngeal cancer patients.
abstract: OBJECTIVE
  To assess adjuvant therapy in patients undergoing surgical management of oropharyngeal squamous cell carcinoma (OPSCCA) with transoral robotic surgery (TORS) and neck dissection.
  
  
  METHODS
  A prospective, nonrandomized, consecutive patient series from two separate protocols in a tertiary academic medical center.
  
  
  METHODS
  Patients undergoing treatment for OPSCCA were selected from a prospective protocol evaluating functional and oncologic outcomes following TORS with a comparator group of OPSCCA patients receiving definitive chemoradiotherapy (CRT) participating in a separate prospective protocol.
  
  
  RESULTS
  Forty-two patients represented the TORS group and 38 the CRT group. Twenty (48%) of the TORS patients received surgery only, whereas nine (21%) underwent adjuvant radiotherapy and 13 (31%) adjuvant CRT. Adjuvant therapy patients had a higher overall T (P =.0007) and N (P < .0001) stage than the TORS-only group. Surgery resulted in stage changes in 18 (43%) patients, leading to alteration in therapy for nine (21%) patients. The 3-year overall survival (OS), disease-specific survival (DSS), and locoregional control was 74% versus 90% (P = .30), 94% versus 94% (P = .91), and 72% versus 91% (P = .19) for the TORS-alone versus TORS plus adjuvant therapy groups, respectively. Comparison with the CRT group revealed a survival benefit in the TORS group approaching significance, with a 3-year OS of 83% versus 57% (P = .06) and DSS of 94% versus 85% (P = .08), respectively.
  
  
  CONCLUSIONS
  Primary surgical management of OPSCCA with TORS and neck dissection provides accurate staging information, which can lead to the appropriate selection of subsequent therapy. This approach does not compromise survival and warrants additional investigation.
  
  
  METHODS
  3b.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.
authors.forename: Richard V
authors.initials: RV
authors.lastname: Smith
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Schiff
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.|Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.
authors.forename: Madhur
authors.initials: M
authors.lastname: Garg
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.|Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.
authors.forename: Missak
authors.initials: M
authors.lastname: Haigentz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D059186:Chemoradiotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D005260:Female; D052162:Human papillomavirus 16; D006801:Humans; D057194:Intention to Treat Analysis; D033183:Interdisciplinary Communication; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D030361:Papillomavirus Infections / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D065287:Robotic Surgical Procedures; D015996:Survival Rate
keywords: Transoral robotic surgery; cancer; de-intensification; human papillomavirus; oropharynx; p16; robotic; stratification; surgery; transoral