Margin Status and Recurrence in Surgically Treated Patients With <scp>HPV</scp>+ Oropharyngeal Cancer

ABSTRACT Background The optimal margins for surgically treated human papilloma virus (HPV)‐related oropharyngeal squamous cell carcinoma (OPSCC) remain undefined. We evaluated the impact of surgical margins on progression‐free survival (PFS) in patients with HPV+ OPSCC treated with primary transoral robotic surgery (TORS). Methods Patients undergoing primary TORS from May 2012 to December 2021 for intermediate‐risk (T1–T2, resected to clear (≥ 3 mm) or close margins (&lt; 3 mm), and N1‐N2) HPV+ OPSCC were included. Survival outcomes were reviewed, and overall and PFS at 3 years posttreatment were determined using Kaplan–Meier analysis. Results A total of 69 subjects met inclusion criteria. At a median follow‐up of 47 months, overall survival (OS) was 100%, and the PFS was 88.9% for the entire subject group. Among subjects not receiving adjunctive radiotherapy (RT), those with close margins had an OS of 100% and a PFS of 100% (median follow‐up 47 months). Subjects with clear margins had an OS probability of 100% and a PFS probability of 100% (median follow‐up 47 months). Conclusion In subjects undergoing TORS for HPV+ OPSCC, clear margins did not confer a significant OS or PFS survival advantage compared to those with close margins, even when adjuvant therapy was omitted. Level of Evidence 3