Transoral Robotic Surgery for Elderly Patients with Oropharyngeal and Laryngeal Cancer: A Comprehensive Review

TL;DR

Transoral robotic surgery (TORS) shows promise for elderly patients with head and neck cancer, offering survival and functional benefits similar to younger patients.

Contribution

This paper provides a comprehensive review of TORS outcomes specifically in elderly patients with head and neck cancer.

Findings

TORS offers comparable disease-specific and disease-free survival in elderly patients as in younger cohorts.

Overall survival in elderly patients is more influenced by comorbidities than age alone.

TORS may reduce the need for adjuvant therapies and improve swallowing function in selected elderly patients.

Abstract

Background/Objectives: Head and neck squamous cell carcinoma (HNSCC) poses a significant health challenge, especially among elderly patients, who are often underrepresented in clinical trials. Transoral robotic surgery (TORS) has emerged as a promising alternative to non-surgical strategies such as chemoradiotherapy (CRT), but its effectiveness in older adults is not well-studied. Methods: A structured narrative review of studies on TORS for elderly HNSCC patients was conducted using the PubMed/MEDLINE database. Studies were selected according to predefined eligibility criteria based on the PICOS framework. PRISMA reporting principles were applied to document study identification and selection. Results: The available evidence suggests that, in carefully selected elderly patients, TORS is associated with disease-specific (DSS) and disease-free survival (DFS) outcomes comparable to those reported in younger cohorts, while overall survival (OS) appears more strongly influenced by comorbidities than chronological age. TORS may facilitate treatment de-escalation in selected cases, potentially reducing exposure to adjuvant therapies and limiting treatment-related toxicity. Functional outcomes, particularly swallowing function and long-term gastrostomy dependence, may be favorable in selected elderly patients; however, comparative data with non-surgical approaches remain limited, heterogeneous, and are partly derived from mixed-age cohorts. Conclusions: TORS represents a viable treatment option for selected elderly HNSCC patients, providing encouraging oncologic outcomes and potential functional advantages. Nevertheless, the current evidence base is predominantly retrospective and heterogeneous. Careful patient selection is essential, and further prospective elderly-specific studies are needed to better define functional and oncologic benefits.

Figures