Transoral robotic surgery (TORS) vs. endoscopy-assisted transoral approach (EATA) for parapharyngeal space tumors: a systematic review and meta-analysis.

Background: Less than 1% of head and neck tumors are in the parapharyngeal space (PPS). With complex anatomy, conventional surgery is challenging. Endoscopy-assisted transoral approach (EATA) minimizes trauma and scarring; however, criticism regarding infeasibility with large tumors led to the introduction of transoral robotic surgery (TORS), which gives a 3D view of the field, reduces operative time, and is effective for larger tumors but faces technical and operational issues. This review compares the outcomes and complications of TORS and EATA.

Methods: We searched four databases for relevant articles up to January 2025. Two independent reviewers extracted data from the selected studies, including baseline information, operative time, blood loss, and hospitalization time.

Results: We reviewed 32 studies, of which 27 provided sufficient data for analysis. These studies involved 348 patients treated for PPS tumors using either EATA or TORS. Operative times were similar for both methods, with EATA averaging 92.31 min and TORS averaging 93.93 min (p = 0.9385). However, compared to EATA, TORS was associated with reduced blood loss (16.98 ml, 95% CI: 9.38-24.59; p < 0.0001) and a shorter hospitalization duration (3.39 days, 95% CI: 2.51-4.27; p = 0.0278). Common complications associated with endoscopy included Horner's syndrome and wound dehiscence, whereas TORS rarely reported severe complications. No fatalities were documented for either method.

Conclusion: TORS is not inferior to EATA regarding operative time, with reduced blood loss and shorter hospital stays..