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

## TL;DR

Transoral robotic surgery with neck dissection offers good long-term outcomes for early-stage hypopharyngeal cancer, but distant metastases and new cancers remain major risks.

## Contribution

This study provides long-term survival data and identifies extranodal extension as a key prognostic factor in transoral robotic surgery for hypopharyngeal cancer.

## Key findings

- Extranodal extension significantly impacts survival and recurrence in hypopharyngeal cancer patients.
- Distant metastases and second primary malignancies are leading causes of late mortality.
- TORS with neck dissection allows organ preservation and radiotherapy omission in selected cases.

## 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.