Oncological Outcomes of Transoral Robotic Surgery and Neck Dissection Without Adjuvant Therapy in Patients With Low-, Intermediate-, and High-Risk Pathological Features in Oropharyngeal Carcinoma-An Institutional Experience.

Authors

Leba M Sarkis, Zeynep Baskurt, Christopher Mkl Yao, Sharon Tzelnick, Shao Hui Huang, Ali Hosni, Ezra Hahn, Scott Bratman, Anna Spreafico, David Goldstein, John R de Almeida

Published in

Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale. Volume 55. Pages 19160216261477650. Epub Oct 13, 2026.

Abstract

Pathologic risk features after transoral robotic surgery (TORS) inform the need for adjuvant therapy in oropharyngeal cancer (OPC); however, traditional risk stratification criteria may not fully apply to oropharyngeal carcinoma treated with TORS, especially for HPV+ disease.
The purpose of this study was to determine oncological outcomes including disease-free survival and overall survival in patients with intermediate-risk and high-risk histopathological features who underwent TORS without adjuvant radiation therapy.
We conducted a cohort study of patients with OPC, with intermediate-risk and high-risk pathological features who underwent primary TORS with neck dissection and without adjuvant treatment between 2015 and 2023 at the Princess Margaret Care Centre in Toronto, Canada.
Adult patients with a diagnosis of oropharyngeal carcinoma treated at the Princess Margaret Cancer Center/University Health Network between January 2015 and December 2023 were included in the study.
Transoral robotic surgical removal of primary oropharyngeal carcinoma with concurrent neck dissection.
Oncologic outcomes assessed included local, regional, and distant recurrence along with disease-free survival (DFS) and overall survival (OS).
Forty-two patients (27 male: 15 female; median age = 58) with 43 primary oropharyngeal cancers were included, of whom 33 (79%) were p16 positive. At a median follow-up of 49 months, 41 patients (98%) remained disease-free. Three patients (7%) developed second primaries in different sites that were successfully salvaged.
Patients with OPC treated with TORS alone have favorable oncologic outcomes, although second primary tumors remain a risk, likely related to field cancerization or multifocality.
Overall survival and locoregional control do not appear to be compromised in patients with OPSCC and adverse intermediate-to-high-risk features on histopathology who do not proceed to adjuvant therapy.

PMID:
42867176
Bibliographic data and abstract were imported from PubMed on 14 Oct 2026.

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