Transoral Robotic Surgery‐Based Treatment Versus Definitive Chemoradiation for Oropharyngeal Squamous Cell Carcinoma: A Systematic Review and Meta‐Analysis

BACKGROUND: Trans-oral robotic surgery is a minimally invasive surgical approach for the treatment of oropharyngeal squamous cell carcinoma (OPSCC), with superior functional outcomes compared to open surgery. However, its oncologic and functional outcomes are still debated in comparison to definitive radiotherapy (RT) or chemoradiotherapy (CRT). METHODS: A systematic search was conducted in PubMed, Scopus, and Embase, and relevant studies were selected in accordance with the PRISMA guidelines. Overall survival, disease-specific survival, and swallowing function are compared between TORS and primary RT or CRT using random-effects models. Dysphagia was assessed using the MD Anderson Dysphagia Index (MDADI) and the Functional Oral Intake Scale (FOIS). RESULTS: A total of 15 studies comprising 6767 patients (2423 underwent TORS and 4344 underwent upfront RT or CRT) were included. Overall survival was significantly better after TORS (HR 0.51; 95% CI 0.42-0.62; p < 0.0001), in all stages of disease, but not in HPV-positive cases. No significant difference was found in progression-free survival (HR 0.81; 95% CI 0.50-1.29; p = 0.374). MDADI and FOIS scores were not significantly different among the two groups (MD 0.8; 95% CI -2, -3.5; p = 0.578; and MD 0.2; 95% CI -0.3, -0.7; p = 0.469; respectively). Compared to baseline, MDADI scores were decreased in both groups; but the decline was almost two-fold larger in the RT/CRT group (MD 3.5; 95% CI 3.1-3.9; p < 0.001). CONCLUSIONS: TORS with or without adjuvant treatment was associated with higher overall survival compared to definitive RT/CRT. TORS was also associated with less decline in functional outcomes compared to baseline. Considering the non-randomized nature of most available studies, these results should be interpreted with caution. Future studies are warranted to determine the optimal treatment strategies for patients with OPSCC and to investigate the implications of HPV status on treatment selection.