Specimen-Based Resection Margins and Local Control during Transoral Robotic Surgery for Oropharyngeal HPV-Mediated Squamous Cell Carcinoma

Kelly R. Magliocca, Azeem S. Kaka, Emily M. Barrow, Matthew B. Studer, Christopher C. Griffith, Jacqueline Ernst, Tara Meade, Andrew Balicki, Brian J. Boyce, Nicole C. Schmitt, Andres M. Bur, Alessandra C. Schmitt, Ryan Jackson, Conor E. Steuer, Jonathan J. Beitler, Mihir R. Patel

Research output: Contribution to journalArticlepeer-review


Objectives: The aim of the study was to investigate the association of surgical margin conditions, including positive specimen margins revised to negative relative to local recurrence, disease-free survival, and overall survival (OS) within a cohort of HPV-mediated oropharyngeal squamous cell carcinoma (OPSCC) who underwent en bloc resection via transoral robotic surgery (TORS). Materials and Methods: Retrospective cohort of patients with untreated HPV-mediated OPSCC cT1 or T2 undergoing TORS resection between October 2014 and March 2020. The methodologic description of our interdisciplinary institutional approach, number of cut-through margins (CTMs) during intraoperative consultation, percentage of final positive margin cases, and disease-free survival and OS stratified by margin status and margin tumor-free distance is identified. Results: 135 patients with primary cT1/T2 HPV-mediated OPSCC met inclusion criteria. Twenty-eight of 135 (20.7%) specimens revealed CTM and were revised during the same operative setting. Three of 135 (2.2%) surgical cases had positive final margin status. Local control rate was 97%. On univariate analysis, margin distance did not impact OS. CTM and final positive margins had lower OS than initially negative margins (p = 0.044). Pathologic N-stage significantly impacted OS (p < 0.001). Conclusions: High local control rate and low final positive margin status confound the study of specimen margin-based techniques in HPV-mediated OPSCC resected en bloc with TORS. Pathologic N-stage may impact OS more than margin status. Larger numbers are needed to confirm differences.

Original languageEnglish
Pages (from-to)80-87
Number of pages8
Issue number2
StatePublished - Apr 1 2023


  • Circumferential margins
  • HPV oropharyngeal carcinoma
  • Transoral robotic surgery
  • Transoral robotic surgery margins and survival


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