SynthesisJournal of robotic surgery2026
A comparative analysis of transoral laser microsurgery and transoral robotic surgery for the treatment of oropharyngeal squamous cell carcinoma.
Synthesis in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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Abstract
Transoral laser microsurgery and transoral robot-assisted surgery are central to organ-preserving management of oropharyngeal squamous cell carcinoma, yet their comparative oncologic and functional performance remains uncertain. We conducted a systematic review and meta-analysis of studies reporting outcomes of adults with histologically confirmed oropharyngeal squamous cell carcinoma treated with either technique as primary transoral therapy. Primary outcomes were overall survival, disease-specific survival, and locoregional recurrence. Proportions and continuous variables were pooled using random-effects models. Seventy-two studies including 20,536 patients were analyzed, comprising 19,036 treated with transoral robotic surgery and 1,500 with transoral laser microsurgery. Baseline characteristics were comparable, with predominantly T1-T2 tonsil or base-of-tongue tumors and high human papillomavirus positivity. Pooled overall survival was higher for transoral robotic surgery than for transoral laser microsurgery (0.93 vs. 0.86; p = 0.0002), while disease-specific survival was identical between techniques (0.94 vs. 0.94; p = 0.61). Rates of local, regional, and overall recurrence showed no significant differences (p > 0.05 for all). Positive margins occurred in 13% and 8% of cases, respectively (p = 0.16). Functional outcomes were generally favorable in both groups, with similar rates of gastrostomy, tracheostomy, poor swallowing, and poor voice. Postoperative bleeding (3% vs. 6%) and overall complications (7% vs. 6%) were low across studies (p > 0.05 for all). Both transoral laser microsurgery and transoral robotic surgery provide excellent disease-specific survival, low recurrence rates, and comparable functional and safety profiles in oropharyngeal squamous cell carcinoma. The higher pooled overall survival observed with transoral robotic surgery likely reflects case-mix rather than intrinsic oncologic superiority, supporting both techniques as guideline-concordant options within organ-preserving treatment pathways.
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