Transoral Robotic Surgery versus Transoral Laser Microsurgery for Oropharyngeal Squamous Cell Carcinoma: A Systematic Review

Abstract

Objective: Transoral robotic surgery (TORS) and transoral laser microsurgery (TLM), have undergone significant evolution for the treatment of oropharyngeal squamous cell (OPSCC). However, few have directly compared both methodologies. The objective of this work was to summarize and compare published data on surgical, functional, and oncological outcomes of TORS and TLM for the treatment of OPSCC. Methods: A literature search of MEDLINE, EMBASE, Web of Science, and The Cochrane Library databases was conducted to review studies that reported outcomes of TORS or TLM for primary OPSCC. Results: Studies that reported outcomes of TORS or TLM for primary OPSCC were included. 24 TORS studies including 801 patients and 14 TLM studies including 823 patients were identified. Only retrospective and non-randomized prospective studies were found. Despite significant heterogeneity and incomplete data, TORS and TLM resulted in similar hospital lengths of stay, operative times, positive margins, complication profiles, and tracheostomy and gastrostomy rates. Limited data suggests similar impacts on swallow function and quality of life; however, this assessment was confounded by adjuvant treatment. While TLM studies reported worse oncological outcomes, this is likely due to larger, more advanced tumors in the TLM group. Conclusions: Due to significant heterogeneity in study design, population characteristics, indications for adjuvant treatment, p16/ HPV status, and tumor stage, it was not possible to make any definitive conclusions about the superiority of one technique over the other. However, pooled analyses suggest that TORS and TLM result in similar surgical, functional, and oncological outcomes for the treatment of OPSCC. To accurately assess the impact of TORS versus TLM on outcomes, especially in combination with possible de-escalation adjuvant treatment protocols for HPV positive tumors, carefully constructed randomized controlled trials must be conducted.