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Head and Neck Surgery

(537) Variables That Impact Recurrence in Oropharyngeal Carcinoma Treated with TORS

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
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    Presenting Author(s)

  • Aditi Katwala, BS

    Medical Student
    Carver College of Medicine
    Chicago, Illinois, United States

    • Co-Author(s)

  • MR

    Madia Russillo, MD

    Resident
    University of Iowa Hospitals and Clinics
    Iowa City, Iowa, United States

    • Co-Author(s)

  • AM

    Alex Michael, MD

    University of Iowa Hospital and Clinics, USA

  • ZA

    Zaid Alqurayshi, MD

    University of Iowa Hospital and Clinics, USA

    • Senior Author(s)

  • Marisa R. Buchakjian, MD, PhD

    Assistant Professor
    University of Iowa, Department of Otolaryngology- Head and Neck Surgery, Division of Head and Neck Oncology and Microvascular Reconstruction
    Iowa City, Iowa, United States

    • Co-Author(s)

  • NP

    Nitin Pagedar, MD

    Assistant Professor, Otolaryngology - Head and Neck Surgery
    University of Iowa Hospital and Clinics
    Iowa City, Iowa, USA

    • Senior Author(s)

  • Rodrigo Bayon, MD

    Clinical Associate Professor
    University of Iowa Hospital and Clinics
    Iowa City, Iowa, United States

Disclosure(s):
Aditi Katwala, BS: No relevant relationships to disclose.
Marisa R. Buchakjian, MD, PhD: No relevant relationships to disclose.
Rodrigo Bayon, MD: No relevant relationships to disclose.


Introduction: We present a single institution cohort of patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with transoral robotic surgery (TORS). The primary aim is to assess if the margin status of intraoperative frozen sections and final resection correlates with disease recurrence. A secondary outcome is to assess for independent variables associated with disease recurrence or overall survival.

Methods: Retrospective case series from October 2012 to October 2020. A REDCap database of patients with OPSCC who underwent TORS resection was created. P16 status, age, gender, race, tobacco and alcohol use, tumor subsite, tumor stage, presence of perineural or lymphovascular invasion, intraoperative frozen margins

Results: A total of 142 cases (126 men, 16 women) with an average age of 60 years old (range 34-88 years) were reviewed. 95% were White and 5% were non-White. Tonsil (47%) and tongue base (46%) were the most involved subsites. 127 (89%) cases were p16 positive, which showed significant association (p < 0.05) with the variables of male gender, tumor subsite being at tonsil or tongue base, early pathological stage (usually stage I), absence of perineural invasion. 92% were without recurrence and no mortality at a median follow up of 42.8 months. 14 cases demonstrated locoregional recurrence. Only p16 status demonstrated significant association with recurrence of which 4 cases were p16 negative. The unadjusted odds of p16 negative status to be associated with recurrence is OR: 4.18 (95% CI: 1.12, 15.56, p=0.033). 25% (n=36) had positive margins on final resection. The presence of positive margins in the final resection did not have a significant association with tumor recurrence (p=0.13).

Conclusions: Early stage p16 positive OPSCC has a favorable prognosis. The only variable associated with disease recurrence in our series was p16 status. The status of intraoperative frozen section margins and final resection margins do not appear to correlate with recurrence. Final resection margin status, presence of perineural invasion or lymphovascular invasion do not appear to be strong contributors to patient outcomes.