Transoral robotic surgery and neck dissection for hypopharyngeal cancer: long-term prognostic factors and survival outcomes

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Abstract
Transoral robotic surgery (TORS) with neck dissection has emerged as an organ-preserving treatment for hypopharyngeal squamous cell carcinoma (HPSCC), but long-term evidence remains limited. This retrospective study evaluated oncologic outcomes, prognostic factors, mortality patterns, and organ preservation in patients with T1–T3 HPSCC. From October 2010 to August 2023, 48 patients without prior upper aerodigestive tract malignancy or irradiation underwent TORS with neck dissection, with or without cisplatin-based neoadjuvant chemotherapy and adjuvant chemoradiation. Tumor stages included T1 (37.5%), T2 (45.8%), and T3 (16.7%), and en bloc resection was achieved in all cases. Pathologic analysis revealed lymph node metastasis in 46.8% and extranodal extension in 17%. Radiotherapy to the primary hypopharynx was omitted in 60% of patients; when administered, the mean dose was approximately 60 Gy. After a mean follow-up of 5.9 ± 3.5 years, 5- and 10-year recurrence-free survival rates were both 69%, while disease-specific survival rates were 77%. Overall survival at 5 and 10 years was 77% and 59%, respectively. Survival and recurrence were significantly associated with extranodal extension in multivariable analysis ( p < 0.05). Of 15 deaths, distant metastases (46.7%) and second primary malignancies (33.3%) were predominant, whereas local recurrence accounted for only 13.3%. TORS with neck dissection provides durable disease control and excellent organ preservation for T1–T3 HPSCC, allowing radiotherapy omission in selected patients, although distant metastases and secondary cancers remain major causes of late mortality.
Funding Information
  • National Yang Ming Chiao Tung University

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