Skip to main content
AAO-HNSF 2024 Annual Meeting & OTO EXPO Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Back

Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Oral Presentations 1 - Head and Neck Surgery

Updated Results: Impact of Margins in HPV-Related Oropharyngeal Squamous Cell Carcinoma Treated With Robotic Surgery

Saturday, September 28, 2024
9:48 AM – 9:54 AM EDT
Location: MBCC, 208
Disclosure(s):
Omar A. Karadaghy, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Michael P. Wu, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Maria Armache, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Nadia L. Samaha, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Danielle M. Gillard, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Swapnil V. Shah, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Abigail E. Reid, BSE:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

William R. R. Ryan, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The evolving treatment landscape of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) includes a focus on what constitutes an adequate surgical margin.

Methods: A multi-institutional retrospective cohort was compiled from Massachusetts Eye and Ear, Johns Hopkins, Nebraska Methodist, and the UCSF. Eligible patients underwent single-modality transoral robotic surgery (TORS) for nonrecurrent HPV+ OPSCC with minimum 2-year follow-up. Associations between surgical margins and oncologic outcomes will be explored using the Kaplan-Meier method.

Results: This study identified 120 qualified cases. Median follow-up was 42 months (range: 0-97 months). Primary sites were base of tongue in 48 cases (40%) and tonsil in 72 patients (60%). Of the total, 76 cases (63.3%) were pT1, and 44 cases (36.7%) were pT2. A 1 mm cutoff was used to distinguish close margins from clear. Close margins were present in 45 cases (37.5%) and clear margins in 75 cases (62.5%). Margins were initially positive in 19 cases (15.8%) and subsequently cleared, these cases being categorized as close. 10 patients (8.3%) experienced recurrence, including four local recurrences (3.3%) occurring at a median 31 months (range 24-75). Just 2 patients with local recurrences had close surgical margins. All patients with local recurrence underwent salvage treatment and are currently alive without disease. Of the patients, 6 (5%) died, including two postoperative deaths and four non-cancer mortalities. Local control, disease-free survival, and overall survival did not differ between close and clear margins. No demographic, oncologic, or treatment variables correlated to disease free or overall survival.

Conclusions: In our multi-institutional cohort of HPV+ OPSCC patients treated with TORS without adjuvant treatment, outcomes did not differ between close and clear margins. This suggests that in early staged HPV+ OPSCC, adjuvant therapy based solely on close surgical margins is an area of de-escalation for further investigation in prospective trials.

    Presenting Author(s)

  • OK

    Omar A. Karadaghy, MD

    Fellow
    Massachusetts Eye and Ear
    Boston, MA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • OK

    Omar A. Karadaghy, MD

    Fellow
    Massachusetts Eye and Ear
    Boston, MA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • MW

    Michael P. Wu, MD

    Resident
    Massachusetts Eye and Ear
    Boston, MA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Maria Armache, MD

    Postdoctoral research fellow
    Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University
    Baltimore, MD, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Nadia L. Samaha, BS

    Research Fellow
    Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University
    Baltimore, MD, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • RB

    Rohith Bhethanabotla, MD

    University of California - San Francisco, United States

    Disclosure information not submitted.

  • DG

    Danielle M. Gillard, MD

    Resident
    University of California - San Francisco
    San Francisco, CA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Swapnil V. Shah, BS

    Medical Student
    Creighton University School of Medicine
    Omaha, NE, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Abigail E. Reid, BSE

    Medical Student
    Creighton University School of Medicine
    Omaha, NE, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • CF

    Carole Fakhry, MD, MPH

    Professor
    Johns Hopkins Medical Institute
    Baltimore, Maryland, United States

    Disclosure information not submitted.

  • William R. R. Ryan, MD

    Professor
    UCSF
    Mill Valley, CA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Jeremy Richmon, MD

    Associate Prof
    Johns Hopkins University School of Medicine
    Baltimore, Maryland, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Andrew J. Holcomb, MD

    Head and neck surgeon
    Nebraska Methodist Health System
    Elkhorn, Nebraska, United States

    Disclosure information not submitted.