Transoral Robotic versus Open Surgical Approaches to Oropharyngeal Squamous Cell Carcinoma by Human Papillomavirus Status

Objectives. (1) Investigate oncologic survival outcomes and (2) analyze the impact of human papillomavirus status on prognosis in patients with oropharyngeal squamous cell carcinoma treated with transoral robotic versus open surgery. Study Design. Retrospective cohort study. Setting. Tertiary care referral center, University of Alabama at Birmingham Hospital. Subjects. One hundred thirty total (65 per treatment arm) with primary oropharyngeal squamous cell carcinoma (OPSCC). Methods. Patients treated for primary oropharyngeal squamous cell carcinoma with either transoral robotic (TORS) or open surgery plus standard of care adjuvant therapy between October 2004 and March 2012 were matched based on TNM staging before a retrospective chart review was performed. Carcinoma tissue was stained both prospectively and retrospectively with CINtec p16-INK4a kits for surrogate human papillomavirus typing. Recurrence-free survival was used to evaluate the impact of human papillomavirus tumor status and method of surgical intervention on prognosis. Results. As a whole, patients treated with transoral robotic surgery survived more frequently (94%, 91%, 89% at 1, 2, 3 years, respectively) than those treated with open surgery (85%, 75%, 73% at 1, 2, 3 years, correspondingly) (P = .035). The subgroup of patients with human papillomavirus-negative malignancies treated with open surgery survived without recurrence less frequently at 1, 2, and 3 year rates of 58%, 25%, 25%, respectively (P < .01). Conclusion. These retrospective data suggest that oncologic outcomes are not being sacrificed when patients with OPSCC are treated with TORS instead of open surgery regardless of tumor human papillomavirus immunohistochemical staining.