title: Adoption of transoral robotic surgery compared with other surgical modalities for treatment of oropharyngeal squamous cell carcinoma.
abstract: OBJECTIVE
  Transoral robotic surgery (TORS) has increased for treatment of oropharyngeal squamous cell carcinoma (OPSCC). To define the adoption of TORS, we analyzed patterns of surgical treatment for OPSCC in the US.
  
  
  METHODS
  Cases of T1-T3 OPSCC treated with surgery between 2010 and 2013 from the National Cancer Database were queried.
  
  
  RESULTS
  Of 3,071 patients who underwent primary surgical management for T1-T3 OPSCC, 846 (28%) underwent TORS. On multivariable analysis, low tumor stage (T2 vs. T1: OR 0.75, CI 0.37-0.51, P < 0.0001; T3 vs. T1: O.R. 0.33, CI 0.28-0.38, P < 0.0001), treatment at an academic cancer center (O.R. 2.23, C.I. 1.29-3.88, P = 0.004) and treatment at a high volume hospital (34-155 cases vs. 1-4 cases: O.R. 9.07, C.I. 3.19-25.79, P < 0.0001) were associated with increased TORS approach. Significant geographic variation was observed, with high adoption in the Middle Atlantic. Positive margin rates were lower when TORS was performed at a high volume versus low volume hospital (8.2% vs. 16.7% respectively, P = 0.001).
  
  
  CONCLUSIONS
  Tumor and non-tumor factors are associated with TORS adoption. This analysis suggests uneven diffusion of this technology in the treatment of OPSCC. J. Surg. Oncol. 2016;114:405-411. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Cracchiolo
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Roman
authors.affiliation: Weill Cornell Medical College, New York, New York.
authors.forename: David I
authors.initials: DI
authors.lastname: Kutler
authors.affiliation: Weill Cornell Medical College, New York, New York.
authors.forename: William I
authors.initials: WI
authors.lastname: Kuhel
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000379:methods*
keywords: oropharyngeal squamous cell carcinoma (OPSCC); positive margins; trans-oral robotic surgery (TORS)