Comparative safety and effectiveness of transoral robotic surgery versus open surgery for oropharyngeal cancer: A systematic review and meta-analysis.

[BACKGROUND] Transoral robotic surgery (TORS) has recently emerged as a surgical technique for oropharyngeal cancer. We performed a systematic review to investigate the clinical safety and effectiveness of robotic surgery compared with conventional open surgery in primary oropharyngeal cancer.

[METHODS] A literature search was conducted using the English-language databases Ovid-MEDLINE, Ovid-Embase, and the Cochrane Library, as well as local databases containing publications through July 2018. The outcomes included demographic characteristics, adverse events, and complications, as well as oncologic, functional, and surgical outcomes.

[RESULTS] Nine papers (n = 574 patients) met the inclusion criteria. Disease-free survival rate was significantly higher in the TORS group than open surgery group (n = 5 studies, RR: 1.13, 95% CI: 1.03, 1.24, I = 0%). Primary TORS compared with open surgery was associated with lower risks of free flap reconstruction (relative risk [RR]: 0.33, 95% confidence interval [CI]: 0.12.0.88, I = 6%). In subgroup analyses, the time to decannulation reconstruction (N = 2 concurrent studies, mean difference [MD]: -6.71, 95% CI: -8.40, -5.03, I = 78%) in the TORS group shortened by 6.7 days than open surgery group. The length of hospital stay showed significant shorter by 1.09 days in three concurrent studies (95% CI -3.49, 1.30, I = 72%).

[CONCLUSIONS] From current non-randomized studies, TORS could have advantage for disease-free survival and lowering the risk of free flap reconstruction compared to open surgery. However, due to lack of relevant studies, oncologic, functional, surgical outcomes including complications of TORS versus open surgery for oropharyngeal cancer are need to be verified with long-term follow-up comparative studies.