HPV-related oral cancer responds well to robotic surgery

Robotic surgery done through the patient's mouth provides excellent results in removing squamous cell carcinoma from the back of the throat, particularly in persons with human papillomavirus (HPV), according to the results of a recent study.

Cancers of the tonsils and base of the tongue were once mainly seen in elderly patients with a history of tobacco and alcohol use, but these diseases are becoming increasingly common in nonsmokers between the ages of 30 and 50 years who are HPV-positive.

In the current study, 66 persons undergoing transoral robotic surgery (TORS) for treatment of tonsillar or base-of-tongue tumors were followed for at least 2 years. A total of 44 patients (72.1%) harbored HPV infection.

The 2-year disease-specific survival rate was 95.1%; the recurrence-free survival rate was 92.4%. These outcomes were comparable to those seen with other surgical and nonsurgical treatments of oropharyngeal cancer, but the less invasive nature of robotic surgery conferred other benefits. For example, nearly all patients (64, or 97.0%) were able to eat orally within 3 weeks after surgery before beginning adjuvant therapy. Only 3 patients (4.5%) required long-term use of a gastrostomy tube, and just 1 (1.5%) needed long-term tracheotomy.

Disease-specific survival was 97.8% for persons with HPV-positive tumors and 88.9% for those with HPV-negative tumors. Recurrence-free survival was 96.0% and 83.3%, respectively. Disease-specific survival was 96.7% for HPV-positive nonsmokers vs 92.3% for HPV-positive smokers or persons with HPV-negative tumors. Recurrence-free survival was 95.0% and 88.5% for HPV-positive nonsmokers vs HPV-positive smokers or persons with HPV-negative tumors, respectively.

“This study demonstrates that excellent functional outcomes and disease control can be achieved with TORS as primary therapy for [oropharyngeal squamous cell carcinoma],” concluded the investigators, adding that especially in nonsmoking patients with HPV-positive tumors, transoral surgery offers an opportunity to decrease morbidity without sacrificing tumor control (Mayo Clin Proc. 2012;87[3]:219-225; www.mayoclinicproceedings.org/article/S0025-6196%2812%2900121-8/fulltext).

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