Oncologic, functional, and economic outcomes of transoral robotic surgery for HPV-associated oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis of pathology and treatment strategies

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Pooled 5-year overall survival 92% (95% CI: 0.90-0.95)

• Primary Outcome: Overall survival rates: 2-year 94%, 3-year 96%, 5-year 92%

• Nnt Or Sensitivity: Functional outcomes: 7% postoperative hemorrhage, 9% tracheostomy rate, 2% long-term gastrostomy dependence

• Confidence Interval: 95% CI: 0.90-0.95 for 5-year overall survival

Clinical Application

Limited to centres with robotic surgical capability and multidisciplinary head and neck teams Relevant to Australian practice where TORS is available in major centres. May inform PBS funding decisions for robotic surgery and support RACGP referral guidelines for HPV-positive oropharyngeal cancers Selected patients with HPV-positive OPSCC who are surgical candidates for TORS

Abstract

The incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has increased substantially. Transoral robotic surgery (TORS) provides detailed pathological assessment that may support risk-adapted treatment strategies; however, integrated evidence on oncologic, functional, and economic outcomes remains limited. To systematically evaluate oncologic, functional, and economic outcomes of TORS-based treatment strategies in patients with HPV-positive OPSCC. A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed, Wiley Online Library, MDPI, Cureus, and medRxiv were searched for studies published between 2019 and 2025. Pre-specified subgroup meta-analyses (randomized/clinical trial versus observational studies, and primary versus salvage settings) were performed using random-effects models for overall survival (OS), postoperative bleeding, tracheostomy rate, and long-term gastrostomy dependence. Twenty-two studies (20 clinical and 2 economic) were included, with 14 contributing to quantitative synthesis. The pooled 2-year OS was 94% (95% CI: 0.90-0.98), the 3-year OS was 96% (95% CI: 0.92-0.99), and the 5-year OS was 92% (95% CI: 0.90-0.95). In the salvage setting, the pooled 2-year OS was 76% (95% CI: 0.71-0.80), with no observed statistical heterogeneity, although based on a limited number of studies. Subgroup analyses indicated higher survival estimates in randomized/clinical trial settings compared with observational cohorts. Functional outcomes were generally favorable, with pooled postoperative hemorrhage of 7% (95% CI: 0.04-0.11), tracheostomy rate of 9% (95% CI: 0.03-0.14), and long-term gastrostomy dependence of 2% (95% CI: 0.00-0.03).Across included studies, TORS provided detailed pathological information that may support risk stratification and inform adjuvant treatment decisions; however, the extent of treatment de-escalation varied across studies. TORS appears to be an effective treatment option in selected patients with HPV-positive OPSCC, with generally favorable oncologic and functional outcomes. However, interpretation of these findings is limited by heterogeneity in study design and patient populations. Further prospective studies are required to clarify its role in treatment de-escalation and long-term outcomes.Registration: PROSPERO (CRD420251240194).

References

1. 1.Hajihosseni, H., Hajitaghizadeh, R., Sharifi, H. R., & Lin, D. (2026). Oncologic, functional, and economic outcomes of transoral robotic surgery for HPV-associated oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis of pathology and treatment strategies. Journal of Robotic Surgery. https://doi.org/10.1016/j.amjoto.2019.07.003