Oropharyngeal cancer treatment: The role of transoral surgery

Purpose of review This article reviews literature pertaining to squamous cell carcinoma (SCC) of the oropharynx and the evolution of transoral surgical (TOS) techniques for its management. Oncologists are recognizing a changing pattern in the cause of oropharyngeal cancer, namely the increasing incidence of HPV-associated tumors. An effort is underway to reduce the morbidity of treatment without jeopardizing survival. This is a timely discussion for reassessment of current standards of care and opening dialogue on treatment de-escalation. Transoral approaches including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) have revolutionized the surgical approach to SCC. Recent findings The incidence of HPV-related oropharyngeal SCC is increasing at epidemic rates. Although there are no studies comparing nonsurgical treatment to TOS in a randomized controlled fashion, there is an abundance of retrospective and prospective reports of TORS and TLM. Both early and advanced-stage oropharyngeal tumors can be managed successfully with surgery, with or without adjuvant therapy. Summary Although there are no hard scientific differences in oncologic outcomes between primary chemoradiation protocols and primary TOS-based approaches, retrospective comparisons support an advantage of primary surgery. In addition, functional outcomes may be superior following TOS treatment. Management of oropharyngeal SCC will most likely continue to be multidisciplinary with an ongoing effort to de-escalate treatment to reduce morbidity.