(0678) Margins Status of Main Specimen in Transoral Robotic Surgery Versus Transoral Laser Surgery

Introduction: Transoral robotic surgery (TORS) is widely used for resection of oropharyngeal squamous cell carcinoma (OPSCC) despite its low-cost effectiveness when compared to transoral laser microsurgery (TLM). Its efficacy and effect on surgical outcomes in patients with OPSCC of the tonsil compared to transoral laser microsurgery resection is unknown. This study investigates the en bloc tumor margins in patients who underwent TORS compared to those who underwent TLM for OPSCC of the palatine tonsil by a single surgeon.

Methods: The medical records of patients from 2020 to 2023 who were diagnosed with OPSCC were collected with approval from the institutional review board (IRB). A chart analysis was done to identify the patients with OPSCC of the tonsil who either underwent TORS or TLM as their primary treatment by a single surgeon. After those patients were identified, surgical margins of the tumor on the main specimen, final margins, lymphovascular invasion (LVI), perineural invasion (PNI), and tumor size were collected. Data analysis was performed with descriptive statistics and using the chi square model with Fisher’s exact test, when applicable.

Results: In total, 57 patients had OPSCC of the palatine tonsil who underwent either TLM or TORS from 2020 to 2023. Of the total, 27 patients underwent TORS and 28 underwent TLM. Additionally, 16 patients had positive margins in the TLM group, and 18 had positive margins in the TORS group on the main specimen, all margins were negative with re-resection during the primary surgery. Also, 31 patients had LVI and 10 had PNI. The average tumor size from robotic resection was 2.54 cm and from laser resection was 2.84cm. There was not a statistical difference in tumor size or margin status between the two groups (p > 0.05).

Conclusions: The main specimen margin status is not affected by the technique used for dissection in OPSCC of the palatine tonsil.