H&N Robotic Surgery Update. April 20, 2025

What´s new in PubMed this week

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Panda S, Gurusamy KS, Thakar A, Mitra S, Dwivedi R, Chiumenti FA. Treatment outcomes for human papillomavirus negative oropharyngeal cancer: A meta-analysis. Eur J Surg Oncol. 2025 Apr 1;51(8):110005. doi: 10.1016/j.ejso.2025.110005. Epub ahead of print. PMID: 40250267.

A meta-analysis coming from the UK.

“Forty-seven studies could be included (randomized controlled trials: 12, 1230 participants; non-randomized cohort studies: 35, 44253 participants). The largest comparison in the non-randomized studies was between upfront surgery and non-surgical intervention [RT/concurrent chemoradiation (CRT)] with 24 studies… Upfront surgery showed superior outcomes in terms of OS and DFS compared with non-surgical modalities in HPV-negative OPSCC, but the observed differences may be due to confounding bias.”

So…

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Li R, Ku JA, Adkins D, Yom SY, Starmer H, Ismaila N, Holsinger FC. Transoral Robotic Surgery in the Multidisciplinary Care of Patients With Oropharyngeal Squamous Cell Carcinoma: ASCO Guideline Clinical Insights. JCO Oncol Pract. 2025 Apr 18:OP2500249. doi: 10.1200/OP-25-00249. Epub ahead of print. PMID: 40249905.

Also see: Holsinger FC, Ismaila N, Adkins DR, Barber BR, Burnette G, Fakhry C, Galloway TJ, Goepfert RP, Miles BA, Paleri V, Patel AA, Roof SA, Starmer HM, Yom SS, Saba NF, Li R, Ku JA. Transoral Robotic Surgery in the Multidisciplinary Care of Patients With Oropharyngeal Squamous Cell Carcinoma: ASCO Guideline. J Clin Oncol. 2025 Feb 11:JCO2402755. doi: 10.1200/JCO-24-02755. Epub ahead of print. PMID: 39933131

This is the most up-dated clinical guideline on TORS, coming from ASCO, it is open-access, and it is a MUST.

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Poissonnet V, Chabrillac E, Segier B, Gorphe P, Wong S, Garrel R, Ferron C, Kaci R, de Monès E, Jegoux F, Schultz P, Culié D, Baudouin R, Evrard D, Goffinet M, Morinière S, Mirghani H, Righini C, Duflo S, Marie JP, Guelfucci B, Atallah S, Brenet E, Bertolus C, Ceruse P, Aubry K, Dufour X, Gallet P, Bastit V, Uro-Coste E, Vergez S. Transoral robotic surgery for salivary carcinomas of the base of tongue: a multicenter REFCOR study. J Robot Surg. 2025 Apr 15;19(1):161. doi: 10.1007/s11701-025-02332-2. PMID: 40234274.

The French are producing interesting collaborative papers.

REFCOR in the French network of experts in rare head and neck tumors (Réseau d’expertise français sur les cancers ORL rares). In this multicenter study they provide data on unusual tumors, which are usually managed by primary surgical treatment. Of course, wherever there is a TORS program on-going, the transoral robotic approach will be the choice, but now we have data to support it.

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PKoerdt S, Sofroniou A, Doll C, Heiland M, Kreutzer K. Remote access sentinel lymph node biopsy in oral cancer. Int J Oral Maxillofac Surg. 2025 Apr 10:S0901-5027(25)00107-9. doi: 10.1016/j.ijom.2025.03.010. Epub ahead of print. PMID: 40221348.

Although upon reading the unstructured abstract you may think that this is a review paper, it is really a case report.

The proposal is to use the retroauricular approach (with robotic instrumentation, da Vinci Xi) to make the sentinel node biopsy. In this case in the right submandibular area (level IIb). The problem here, of course, is that if the node is positive the patient will require a comprehensive neck dissection and there is no way to combine the retroauricular incision with a conventional one. So, in my view, there is no indication unless you are able to also perform a robotic lateral neck dissection through a retroauricular approach.

J Granell. April 20, 2025.