Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma

Andrew J. Holcomb; Matthew Herberg; Madeleine Strohl; Edgar Ochoa; Allen L. Feng; Nicholas B. Abt; Tara E. Mokhtari; Krish Suresh; Christopher I. McHugh; Anuraag S. Parikh; Peter Sadow; William Faquin; Daniel Faden; Daniel G. Deschler; Mark A. Varvares; Derrick T. Lin; Carole Fakhry; William R. Ryan; Jeremy D. Richmon

doi:10.1002/hed.26708

Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma

Andrew J. Holcomb, Matthew Herberg, Madeleine Strohl, Edgar Ochoa, Allen L. Feng, Nicholas B. Abt, Tara E. Mokhtari, Krish Suresh, Christopher I. McHugh, Anuraag S. Parikh, Peter Sadow, William Faquin, Daniel Faden, Daniel G. Deschler, Mark A. Varvares, Derrick T. Lin, Carole Fakhry, William R. Ryan, Jeremy D. Richmon

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: The impact of close surgical margins on oncologic outcomes in HPV-related oropharyngeal squamous cell carcinoma (HPV + OPSCC) is unclear. Methods: Retrospective case series including patients undergoing single modality transoral robotic surgery (TORS) for HPV + OPSCC at three academic medical centers from 2010 to 2019. Outcomes were compared between patients with close surgical margins (<1 mm or requiring re-resection) and clear margins using the Kaplan–Meier method. Results: Ninety-nine patients were included (median follow-up 21 months, range 6–121). Final margins were close in 22 (22.2%) patients, clear in 75 (75.8%), and positive in two (2.0%). Eight patients (8.1%) recurred, including two local recurrences (2.0%). Four patients died during the study period (4.0%). Local control (p = 0.470), disease-free survival (p = 0.513), and overall survival (p = 0.064) did not differ between patients with close and clear margins. Conclusions: Patients with close surgical margins after TORS for HPV + OPSCC without concurrent indications for adjuvant therapy may be considered for observation alone.

Original language	English (US)
Pages (from-to)	2434-2444
Number of pages	11
Journal	Head and Neck
Volume	43
Issue number	8
DOIs	https://doi.org/10.1002/hed.26708
State	Published - Aug 2021

Keywords

human papillomavirus
oropharynx
squamous cell carcinoma
surgical margins
transoral robotic surgery

ASJC Scopus subject areas

Otorhinolaryngology

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10.1002/hed.26708

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Holcomb, A. J., Herberg, M., Strohl, M., Ochoa, E., Feng, A. L., Abt, N. B., Mokhtari, T. E., Suresh, K., McHugh, C. I., Parikh, A. S., Sadow, P., Faquin, W., Faden, D., Deschler, D. G., Varvares, M. A., Lin, D. T., Fakhry, C., Ryan, W. R., & Richmon, J. D. (2021). Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma. Head and Neck, 43(8), 2434-2444. https://doi.org/10.1002/hed.26708

Holcomb, AJ, Herberg, M, Strohl, M, Ochoa, E, Feng, AL, Abt, NB, Mokhtari, TE, Suresh, K, McHugh, CI, Parikh, AS, Sadow, P, Faquin, W, Faden, D, Deschler, DG, Varvares, MA, Lin, DT, Fakhry, C, Ryan, WR & Richmon, JD 2021, 'Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma', Head and Neck, vol. 43, no. 8, pp. 2434-2444. https://doi.org/10.1002/hed.26708

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title = "Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma",

abstract = "Background: The impact of close surgical margins on oncologic outcomes in HPV-related oropharyngeal squamous cell carcinoma (HPV + OPSCC) is unclear. Methods: Retrospective case series including patients undergoing single modality transoral robotic surgery (TORS) for HPV + OPSCC at three academic medical centers from 2010 to 2019. Outcomes were compared between patients with close surgical margins (<1 mm or requiring re-resection) and clear margins using the Kaplan–Meier method. Results: Ninety-nine patients were included (median follow-up 21 months, range 6–121). Final margins were close in 22 (22.2%) patients, clear in 75 (75.8%), and positive in two (2.0%). Eight patients (8.1%) recurred, including two local recurrences (2.0%). Four patients died during the study period (4.0%). Local control (p = 0.470), disease-free survival (p = 0.513), and overall survival (p = 0.064) did not differ between patients with close and clear margins. Conclusions: Patients with close surgical margins after TORS for HPV + OPSCC without concurrent indications for adjuvant therapy may be considered for observation alone.",

keywords = "human papillomavirus, oropharynx, squamous cell carcinoma, surgical margins, transoral robotic surgery",

author = "Holcomb, {Andrew J.} and Matthew Herberg and Madeleine Strohl and Edgar Ochoa and Feng, {Allen L.} and Abt, {Nicholas B.} and Mokhtari, {Tara E.} and Krish Suresh and McHugh, {Christopher I.} and Parikh, {Anuraag S.} and Peter Sadow and William Faquin and Daniel Faden and Deschler, {Daniel G.} and Varvares, {Mark A.} and Lin, {Derrick T.} and Carole Fakhry and Ryan, {William R.} and Richmon, {Jeremy D.}",

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year = "2021",

month = aug,

doi = "10.1002/hed.26708",

language = "English (US)",

volume = "43",

pages = "2434--2444",

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T1 - Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma

AU - Holcomb, Andrew J.

AU - Herberg, Matthew

AU - Strohl, Madeleine

AU - Ochoa, Edgar

AU - Feng, Allen L.

AU - Abt, Nicholas B.

AU - Mokhtari, Tara E.

AU - Suresh, Krish

AU - McHugh, Christopher I.

AU - Parikh, Anuraag S.

AU - Sadow, Peter

AU - Faquin, William

AU - Faden, Daniel

AU - Deschler, Daniel G.

AU - Varvares, Mark A.

AU - Lin, Derrick T.

AU - Fakhry, Carole

AU - Ryan, William R.

AU - Richmon, Jeremy D.

PY - 2021/8

Y1 - 2021/8

N2 - Background: The impact of close surgical margins on oncologic outcomes in HPV-related oropharyngeal squamous cell carcinoma (HPV + OPSCC) is unclear. Methods: Retrospective case series including patients undergoing single modality transoral robotic surgery (TORS) for HPV + OPSCC at three academic medical centers from 2010 to 2019. Outcomes were compared between patients with close surgical margins (<1 mm or requiring re-resection) and clear margins using the Kaplan–Meier method. Results: Ninety-nine patients were included (median follow-up 21 months, range 6–121). Final margins were close in 22 (22.2%) patients, clear in 75 (75.8%), and positive in two (2.0%). Eight patients (8.1%) recurred, including two local recurrences (2.0%). Four patients died during the study period (4.0%). Local control (p = 0.470), disease-free survival (p = 0.513), and overall survival (p = 0.064) did not differ between patients with close and clear margins. Conclusions: Patients with close surgical margins after TORS for HPV + OPSCC without concurrent indications for adjuvant therapy may be considered for observation alone.

AB - Background: The impact of close surgical margins on oncologic outcomes in HPV-related oropharyngeal squamous cell carcinoma (HPV + OPSCC) is unclear. Methods: Retrospective case series including patients undergoing single modality transoral robotic surgery (TORS) for HPV + OPSCC at three academic medical centers from 2010 to 2019. Outcomes were compared between patients with close surgical margins (<1 mm or requiring re-resection) and clear margins using the Kaplan–Meier method. Results: Ninety-nine patients were included (median follow-up 21 months, range 6–121). Final margins were close in 22 (22.2%) patients, clear in 75 (75.8%), and positive in two (2.0%). Eight patients (8.1%) recurred, including two local recurrences (2.0%). Four patients died during the study period (4.0%). Local control (p = 0.470), disease-free survival (p = 0.513), and overall survival (p = 0.064) did not differ between patients with close and clear margins. Conclusions: Patients with close surgical margins after TORS for HPV + OPSCC without concurrent indications for adjuvant therapy may be considered for observation alone.

KW - human papillomavirus

KW - oropharynx

KW - squamous cell carcinoma

KW - surgical margins

KW - transoral robotic surgery

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Impact of surgical margins on local control in patients undergoing single-modality transoral robotic surgery for HPV-related oropharyngeal squamous cell carcinoma

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