Transoral robotic surgery for oropharyngeal squamous cell carcinoma in the era of human papillomavirus

Background The emergence of transoral robotic surgery (TORS) ignited the debate between surgical and nonsurgical strategies on oropharyngeal squamous cell carcinoma (SCC) management; a question further complicated by human papillomavirus (HPV). We evaluated the survival by treatment strategy independently in HPV‐related and HPV‐nonrelated oropharyngeal SCC. Methods The National Cancer Database was queried for patients with oropharyngeal SCC with known HPV status who underwent primary TORS or primary radiotherapy. The overall survival (OS) was compared by treatment strategy, including propensity matching to control for confounders. Results Of 1873 patients, 73% were HPV‐positive and 30% were treated with TORS. The propensity‐matched patients with HPV‐positive disease displayed no significant difference in 3‐year survival; 95% versus 91% (P = .116) for the TORS versus primary radiotherapy. In the HPV‐negative cohort, TORS was associated with superior survival; 84% versus 66% (P = .01). Conclusion The TORS‐based approach was associated with superior survival in patients with HPV‐negative oropharyngeal SCC; similar difference was not observed in patients with HPV‐positive disease.