The Laryngoscope V C 2011 The American Laryngological, Rhinological and Otological Society, Inc. Transoral Robotic Resection and Reconstruction for Head and Neck Cancer Eric M. Genden, MD; Tamar Kotz, MS, CCC-SLP; Charles C. L. Tong, MS; Claris Smith, BA; Andrew G. Sikora, MD, PhD; Marita S. Teng, MD; Stuart H. Packer, MD; William L. Lawson, MD; Johnny Kao, MD Objectives/Hypothesis: To evaluate the patterns of failure, survival, and functional outcomes for patients treated with transoral robotic surgery (TORS) and compare these results with those from a cohort of patients treated with concurrent che- moradiation (CRT). Study Design: Prospective non-randomized case control study. Methods: Between April 2007 and April 2009, 30 patients with head and neck squamous cell carcinoma were treated with primary TORS and adjuvant therapy as indicated on an institutional review board–approved protocol. Patients were eval- uated before treatment, after treatment, and at subsequent 3-month intervals after completing treatment to determine their disease and head and neck–specific functional status using the Performance Status Scale for Head and Neck Cancer and the Functional Oral Intake Score (FOIS). Functional scores were compared to a matched group of head and neck patients treated with primary CRT. Results: The TORS patient population included 73% stage III-IV and 23% nonsmokers. The median follow-up was 20.4 months (range, 12.8–39.6 months). The 18-month locoregional control, distant control, disease-free survival, and overall sur- vival were 91%, 93%, 78%, and 90%, respectively. Compared to the primary CRT group, TORS was associated with better short-term eating ability (72 vs. 43, P ¼ .008), diet (43 vs. 25, P ¼ .01), and FOIS (5.5 vs. 3.3, P < .001) at 2 weeks after com- pletion of treatment. In contrast to TORS patients who returned to baseline, the CRT group continued to have decreased diet (P ¼ .03) and FOIS (P ¼ .02) at 12 months. Conclusions: Our early experience in treating selected head and neck cancers with TORS is associated with excellent oncologic and functional outcomes that compare favorably to primary CRT. Key Words: Transoral robotic surgery, head and neck cancer, quality of life, oropharyngeal cancer, head and neck squamous cell carcinoma. Level of Evidence: 2c. Laryngoscope, 121:1668–1674, 2011 INTRODUCTION Because locoregional control and overall survival are similar following primary surgery or radiotherapy for stage-matched squamous cell carcinomas of the head and neck (SCCHN), selection of treatment modality is often determined by toxicity and functional outcomes. 1,2 Historically, surgical extirpation of oropharyngeal tumors was often managed with labiotomy and mandibu- lotomy to gain access to the oropharynx. 1,3–7 Parsons et al. reported an acute complication rate as high as 23% for patients treated with primary open surgery, compared to 6% for patients treated with primary radio- therapy. 8 Further, these major ablative surgical procedures required extensive free flap reconstruction and, in many cases, did not obviate the need for adju- vant radiotherapy. 1,3–7 As a result, most patients with oropharyngeal cancers are currently treated either with primary radiotherapy or, increasingly, with concurrent chemotherapy. 9 Although locoregional control is excel- lent when oropharyngeal cancer is treated with intensity-modulated radiation therapy (IMRT), the rate of complications related to combined chemoradiation (CRT) can be overwhelmingly high. 9–11 Although pri- mary radiotherapy was always associated with nontrivial rates of severe mucositis, increasing use of concurrent CRT has further increased rates of acute tox- icity. 12 Acute toxicity approaches the limits of tolerability, particularly in regimens using induction chemotherapy and/or accelerated fractionated radiation with concurrent CRT with rates of acute grade 3 toxic- ity approaching 90%. 11,13,14 Recent data suggest that intensification of treatment regimens also increases rates of late toxicity. 15,16 From the Mount Sinai School of Medicine Departments of Otolaryngology–Head and Neck Surgery (E.M.G., T.K., C.C.L.T., C.S., A.G.S., M.S.T., W.L.L.), Radiation Oncology (C.C.L.T., J.K.), Medical Oncology (S.H.P .), Dermatology (A.G.S.), and Immunology (E.M.G., A.G.S.), and the Tisch Cancer Institute (E.M.G., A.G.S., M.S.T., S.H.P ., J.K.), New York, New York, U.S.A. Editor’s Note: This Manuscript was accepted for publication December 16, 2010. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Eric M. Genden, MD, FACS, Professor and Chairman, Department of Otolaryngology–Head and Neck Surgery, Pro- fessor of Neurosurgery, Director, Head and Neck Cancer Center, The Mount Sinai Medical Center, Box 1189, 5 East 98th Street, 8th Floor, New York, NY 10029. E-mail: eric.genden@mountsinai.org DOI: 10.1002/lary.21845 Laryngoscope 121: August 2011 Genden et al.: Transoral Robotic Surgery for SCCHN 1668