Transoral Robotic Surgery May Improve Outcomes in Early-Stage Oropharyngeal Cancer

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Robotic surgery for patients with early-stage oropharyngeal squamous cell cancer may be associated with improved health outcomes, including better long-term survival, according to a study published by Nguyen et al in JAMA Oncology.

Transoral robotic surgery is a minimally invasive procedure in which a surgeon uses a computer-enhanced system to guide an endoscope to provide high-resolution, three-dimensional images of the back of the mouth and throat, an area that is difficult to reach with conventional tools. Two robotically guided instruments, acting as a surgeon’s arms, work around corners to safely remove tumors from surrounding tissue.

“At a minimum, robotic surgery for [patients with] oropharyngeal cancer seems safe and effective compared to what’s been the standard of care for many years,” said senior study author Zachary S. Zumsteg, MD, Assistant Professor of Radiation Oncology at Cedars-Sinai Medical Center, referring to standard surgery, radiation therapy, and chemotherapy.

Study Findings

The retrospective, observational study, which used data from the National Cancer Database, included 9,745 surgical patients, 2,694 of whom underwent transoral robotic surgery between 2010 and 2015. The authors found that the 5-year overall survival rate for patients with early-stage disease who underwent robotic surgery was 84.5%, compared with 80.3% for patients who had nonrobotic surgery, after adjusting for differences in health and other characteristics of the two patient groups.

The researchers also observed that the proportion of patients undergoing transoral robotic surgery for early-stage oropharyngeal cancer greatly increased after the U.S. Food and Drug Administration (FDA) approved the surgery for the malignancy in 2009—from 18.3% in 2010 to 35.5% in 2015. Additionally, the proportion of facilities performing transoral robotic surgery during that same period more than doubled, from 6.3% to 13.9%.

The nationwide increase in transoral robotic surgery for oropharyngeal cancer prompted the investigators to assess whether the theoretical benefits of robotic surgery for oropharyngeal cancer actually provide outcomes that are superior or equivalent to the standard treatments for that cancer type and others.

In addition to increased overall survival rates, the researchers found that robotic surgery was associated with lower rates of positive surgical margins—12.5%—compared with a rate of 20.3% for nonrobotic surgery in patients with oropharyngeal cancer. Furthermore, robotic surgery was associated with less use of postoperative chemoradiation, at 28.6%, compared with 35.7% for patients who had nonrobotic surgery.

“Our purpose in doing this study was to see how this new technology, which has never been tested in a randomized, controlled trial, has influenced patterns of treatment and outcomes since its FDA approval,” said Dr. Zumsteg. “There is a learning curve with any new surgical technique, and new ones don't always translate into equal or improved outcomes.”

Referring to their study results as “hypothesis-generating,” the researchers hope it will inform future randomized, controlled clinical trials.

Disclosure: The study was supported in part by Cedars-Sinai Cancer. For full disclosures of the study authors, visit

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