title: The role of transoral robotic surgery in the management of oropharyngeal cancer.
abstract: OBJECTIVE
  The rising incidence of oropharyngeal squamous cell carcinoma (OPSCC), in large part as a result of the human papillomavirus (HPV), has driven a movement for the change in the management strategies. Renewed interest in minimally invasive approaches of endoscopic head and neck surgery led to introduction of transoral surgery, including transoral robotic surgery (TORS).
  
  
  RESULTS
  Several recent studies, based on large multi-institutional studies and systematic reviews of the literature, have shown excellent oncologic and functional outcomes with TORS for OPSCC. Also, a growing amount of clinical evidence supports the use of TORS in the management of carcinoma of unknown primary site and in selected patients with recurrent OPSCC with acceptable oncologic and better functional outcomes in comparison with traditional surgical approaches. Comparative studies with other therapeutic modalities (conventional surgical and nonsurgical) showed that TORS can be used to treat OPSCC, reducing morbidity and treatment costs, while providing equivalent oncologic results.
  
  
  CONCLUSIONS
  Large and robust data available in the literature supports the role of TORS within the multidisciplinary treatment paradigm for the management of OPSCC. Information from ongoing randomized clinical trials comparing TORS with and without dose-reduced radiotherapy or with and without intensified adjuvant treatment for high-risk OPSCC patients is necessary to determine the role of de-escalation of therapy in the era of HPV and OPSCC.
authors.affiliation: aHead and Neck Surgery Service, Brazilian National Cancer Institute (INCA), Department of Head and Neck Surgery, Post Graduate School of Medicine, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro bDepartment of Otolaryngology and Head and Neck Surgery, Escola Paulista de Medicina (EPM), Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Fernando L
authors.initials: FL
authors.lastname: Dias
authors.forename: Fernando
authors.initials: F
authors.lastname: Walder
authors.forename: Fernando Danelon
authors.initials: FD
authors.lastname: Leonhardt