IN a significant update for head and neck oncology care, new clinical insights into transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPC) aim to guide U.S. physicians in tailoring treatment plans through a multidisciplinary lens. The recommendations offer a comprehensive framework for assessing TORS candidacy and integrating it with patient-centered decision-making.
Developed by a panel of oncology experts, the guidelines help clinicians assess the use of TORS based on tumor characteristics, human papillomavirus (HPV) status, and patient-specific functional risks. A key focus is balancing oncologic outcomes with functional preservation, particularly speech and swallowing function, which are often impacted by traditional therapies.
Before considering TORS, a robust pretreatment evaluation, including physical examination, radiologic imaging, HPV DNA testing, and dental and speech-language pathology consults, is essential. Up to 50% of patients with oropharyngeal cancer show baseline swallowing dysfunction, making early speech therapy engagement a critical step toward reducing post-surgical complications and improving recovery trajectories.
The insights also underscore the need for clear communication about treatment risks and benefits. While TORS offers the potential for improved swallow outcomes and shorter treatment durations, patients must be informed of possible complications such as oropharyngeal hemorrhage. Notably, adjuvant therapy may still be required post-surgery depending on pathologic findings.
Ideal candidates for TORS include patients with T1-T2, lateralized OPC, minimal nodal burden, and no contralateral neck disease. However, multidisciplinary discussions are vital for cases involving borderline or midline tumors, anticoagulation therapy, or potential for escalated therapy due to extranodal extension.
By equipping physicians with structured guidance and emphasizing personalized treatment planning, the new TORS-focused recommendations aim to empower healthcare teams and improve outcomes for patients with OPC.
Reference: Li R et al. Transoral Robotic Surgery in the Multidisciplinary Care of Patients With Oropharyngeal Squamous Cell Carcinoma: ASCO Guideline Clinical Insights. JCO Oncol Pract. 2025;00:1-4.
