The following is a summary of “Transoral robotic surgery without adjuvant therapy: A systematic review and meta-analysis of the association between surgical margins and local recurrence,” published in the December 2023 issue of Oncology by Williamson, et al.

For a systematic review and meta-analysis, researchers sought to focus on the use of transoral robotic surgery (TORS) in the therapy of oropharyngeal cancer without the use of adjuvant medication. They emphasized the need for safe surgical margins to avoid local recurrence (LR). A total of 406 patients were included in 11 different trials that were analyzed.

It was shown that there was a 7% incidence of positive margins and a 7% incidence of near margins when the pooled rates were analyzed. When the margin was positive, the overall rate of LR was 6%, but it increased to 13%, and when the margin was close, it dropped to 3%. About the odds ratio for LR, it was found that the probability of positive margins was larger than that of close margins (OR 7.5). The probability of near margins was somewhat lower than negative margins (OR 2.22). The absence of frozen-section analysis (odds ratio: 2.91), as well as the presence of HPV-negative illness (odds ratio: 1.68), were both factors that were linked with an increased risk of LR.

The research concluded that TORS, when used as a solo therapy, is associated with low LR rates; nevertheless, the literature is confronted with issues because of the significant variation in margin definitions. To determine accurate margin cut-offs for oropharyngeal tumors that are handled with TORS alone, it was advised that larger multicenter trials be conducted.

Source: sciencedirect.com/science/article/abs/pii/S1368837523003068