Minimizing adjuvant treatment after transoral robotic surgery through surgical margin revision and exclusion of radiographic extracapsular extension: A Prospective observational cohort study

ABSTRACT Background We investigated in a prospective cohort of patients treated with trans‐oral robotic surgery (TORS) for oropharyngeal cancer (OPC), who were selected for the absence of radiographic extra‐capsular extension (ECS) and surgically revised for inadequate margins, the possibility of reducing adjuvant radiation (RT)/chemo‐radiation therapy (CRT) without jeopardizing tumor control and functional outcome. Methods We conducted a prospective observational cohort of patients treated with TORS for oropharyngeal cancer. Results Twenty‐nine patients with T1/2N0 to N2B stage cancers were treated with TORS. Forty‐five percent of them were treated for secondary primaries. Nine of 29 patients (31%) were revised for close/positive margins. Adjuvant RT was prescribed for 2 of 19 patients with early squamous cell carcinoma (SCCs) and CRT for 1 of 10 patients with advanced oropharyngeal SCCs. Overall survival (OS), disease‐specific survival (DSS), and locoregional control at 2 years were 85%, 96%, and 93%, respectively. Posttreatment Functional Outcome Swallowing Scale (FOSS) scores worsened with prior or adjuvant RT, local recurrence, site, and revision for margins. Conclusion Patients with early and moderately advanced oropharyngeal SCC selected for radiographic ECS and revised for inadequate margins have excellent tumor control and favorable functional recovery. © 2017 Wiley Periodicals, Inc. Head Neck 39: 965–973, 2017