Introduction: The study analyses retrospective characterization of the oncological and
functional characteristics of patients with HPV-negative oropharyngeal squamous cell carcinoma
(OPSCC) treated with Trans Oral Robotic Surgery (TORS), as well as the impact that numerous
pathological and surgical factors may have on outcomes. In addition, we aim to provide a longterm
description of swallowing and functional recovery after TORS.
Methods: Patients treated for HPV-negative OPSCC underwent TORS, using the daVinci Surgical
system, and had their clinical data recorded from the period of 2012 to 2021 in the Department
of ORL and Head and Neck Surgery of the CHUV Lausanne. Overall Survival (OS), Disease Specific
Survival (DSS), Relapse Free Survival (RFS), and Cause Specific Survival (CSS) of the patients is
evaluated, as well as histologic-pathological data of their cancer, and postoperative swallowing
function through a Functional Oral and Swallowing Status (FOSS) Score.
Results: Our study included 38 patients, with ages ranging from 47 to 80 and a median age of 64
years. The cohort of median 3 years follow-up was composed of 63.2% men (n=24) and 36.8%
women (n=14). Tumor staging distribution was as follows: 10.5% (n=4) in-situ, 36.9% (n=14)
cT1, 39.5% (n=15) cT2, and 10.5% (n=4) cT3. 28.9% (n=11) of the patients had a prior history of
cancer. High Disease Specific Survival (DSS) rates were observed among patients who
underwent tumor removal by TORS, despite lower Overall Survival (OS) rates. Lymphovascular
invasion emerged as a significant adverse prognostic factor for Relapse Free Survival (RFS) and
Overall Survival (OS). Survival prognosis was not significantly affected by whether a margin
revision, a radiotherapy, or a chemotherapy, were carried out or not. Out of the cohort, 34
patients had complete records of preoperative, 3-month postoperative, and final FOSS scores,
with the final score recorded after minimum 7 months post-surgery depending on the patient
and up to 100 months. Majority of patients generally demonstrated low preoperative FOSS
scores, and their final FOSS scores indicated significant preservation of oral and swallowing
function.
Conclusions: Our study presents promising results, demonstrating preserved swallowing
function as indicated by stable FOSS scores, and a high Disease Specific Survival (DSS) rate, even
in the presence of patients' severe initial comorbidities. Notably, lymphovascular invasion
correlates with poorer outcomes, whereas margin revision or adjuvant therapy does not
significantly impact survival prognosis.