Meta-analysis of margins and outcomes after transoral robotic surgery in human papillomavirus-associated oropharyngeal cancer

To determine the effect of margin distance on outcomes in patients with HPV + oropharyngeal squamous cell carcinoma (OPSCC) after transoral robotic surgery (TORS). Obtained from a database search of PubMed, EMBASE, and Google Scholar using an a priori protocol with dual independent evaluation for inclusion, risk of bias assessment, and extraction of data for analysis. Articles that reported surgical margin distance and recurrence data after TORS in patients with HPV + OPSCC were included. Random-effects meta-analysis was used to pool data from studies. Rates of local, regional, and distance recurrences were compared across three groups: <1 mm, 1–2 mm, and >2 mm. A total of 7 articles comprising 1150 patients were included in the analysis. The majority were tonsil primary (54 %), T1-T2 (94 %), and N+ (86 %). Adjuvant radiation with or without chemotherapy was given to 846 patients (74 %). Most patients had a >2 mm margin after resection (72 %). Local, regional, or distant recurrence was observed in 14 % of patients with <1 mm margin, 10 % of patients with 1–2 mm margin, and 6 % of patients with >2 mm margin. There were no statistically significant differences in rates of any type of recurrence based on margin status. Low rates of recurrence were observed after TORS in patients with HPV + OPSCC regardless of margin distance. Most patients received adjuvant therapy post-operatively at variable rates, obscuring the true effect of margin status on oncologic outcomes. Further investigation of de-escalation protocols in controlled clinical trials are needed to reduce uncertainty and to provide information on disease-free and overall survival rates.