Transoral robotic approaches to parapharyngeal space malignancies: a Systematic Review.

Objective: Transoral robotic surgery (TORS) has emerged as a promising alternative to conventional open approaches for parapharyngeal space (PPS) malignancies. This review aimed to evaluate the surgical indications, oncologic efficacy, and functional outcomes of robotic-assisted procedures. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. PubMed, Scopus, and Cochrane databases were searched for studies published between 2007 and 2025. Eligible studies included patients with PPS malignancies managed by TORS or combined TORS-open approaches. Results: Eleven studies, comprising 20 patients, met the inclusion criteria. Ten patients underwent TORS-only resection, with no intraoperative or postoperative complications and no evidence of recurrence during follow-up. Eight patients were treated with combined TORS-open approaches, achieving comparable oncologic control, albeit with a higher rate of tracheostomy and feeding tube placement. Conclusion: TORS-only represents a valid strategy for selected small and well-localized PPS malignancies, ensuring favourable oncologic and functional outcomes. Combined TORS-open approaches expand surgical indications to larger and anatomically complex tumours, while maintaining acceptable morbidity and oncologic results.