{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T05:36:35Z","timestamp":1791005795401,"version":"4.1.0"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"<jats:sec id=\"ab-ooi230045-4\"><jats:title>Importance<\/jats:title><jats:p>Due to lack of data from high-powered randomized clinical trials, the differences in functional and survival outcomes for patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing primary transoral robotic surgery (TORS) vs primary radiation therapy and\/or chemoradiation therapy (RT\/CRT) are unclear.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230045-5\"><jats:title>Objectives<\/jats:title><jats:p>To compare 5-year functional (dysphagia, tracheostomy dependence, and gastrostomy tube dependence) and survivorship outcomes in patients with T1-T2 OPSCC receiving primary TORS vs RT\/CRT.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230045-6\"><jats:title>Design, Setting, and Population<\/jats:title><jats:p>This national multicenter cohort study used data from a global health network (TriNetX) to identify differences in functional and survival outcomes among patients with OPSCC who underwent primary TORS or RT\/CRT in 2002 to 2022. After propensity matching, 726 patients with OPSCC met inclusion criteria. In the TORS group, 363 (50%) patients had undergone primary surgery, and in the RT\/CRT group, 363 (50%) patients had received primary RT\/CRT. Data analyses were performed from December 2022 to January 2023 using the TriNetX platform.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230045-7\"><jats:title>Exposure<\/jats:title><jats:p>Primary surgery with TORS or primary treatment with radiation therapy and\/or chemoradiation therapy.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230045-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Propensity score matching was used to balance the 2 groups. Functional outcomes were measured at 6 months, 1 year, 3 years, 5 years, and more than 5 years posttreatment and included dysphagia, gastrostomy tube dependence, and tracheostomy dependence according to standard medical codes. Five-year overall survivorship was compared between patients undergoing primary TORS vs RT\/CRT.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230045-9\"><jats:title>Results<\/jats:title><jats:p>Propensity score matching allowed a study sample with 2 cohorts comprising statistically similar parameters with 363 (50%) patients in each. Patients in the TORS cohort had a mean (SD) age of 68.5 (9.9) vs 68.8 (9.7) years in RT\/CRT cohort; 86% and 88% were White individuals, respectively; 79% of patients were men in both cohorts. Primary TORS was associated with clinically meaningful increased risk of dysphagia at 6 months (OR, 1.37; 95% CI, 1.01-1.84) and 1 year posttreatment (OR, 1.71; 95% CI, 1.22-2.39) compared with primary RT\/CRT. Patients receiving surgery were less likely to be gastrostomy tube dependent at 6 months (OR, 0.46; 95% CI, 0.21-1.00) and 5 years posttreatment (risk difference, \u22120.05; 95% CI, \u22120.07 to \u22120.02). Differences in overall rates of tracheostomy dependence (OR, 0.97; 95% CI, 0.51-1.82) between groups were not clinically meaningful. Patients with OPSCC, unmatched for cancer stage or human papillomavirus status, who received RT\/CRT had worse 5-year overall survival than those who underwent primary surgery (70.2% vs 58.4%; hazard ratio, 0.56; 95% CI, 0.40-0.79).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230045-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This national multicenter cohort study of patients undergoing primary TORS vs primary RT\/CRT for T1-T2 OPSCC found that primary TORS was associated with a clinically meaningful increased risk of short-term dysphagia. Patients treated with primary RT\/CRT had an increased risk of short- and long-term gastrostomy tube dependence and worse 5-year overall survival than those who underwent surgery.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2023.1944","type":"journal-article","created":{"date-parts":[[2023,7,9]],"date-time":"2023-07-09T15:30:25Z","timestamp":1688916625000},"page":"980","source":"Crossref","is-referenced-by-count":29,"title":["Differences in Functional and Survival Outcomes Between Patients Receiving Primary Surgery vs Chemoradiation Therapy for Treatment of T1-T2 Oropharyngeal Squamous Cell Carcinoma"],"prefix":"10.1001","volume":"149","author":[{"given":"Dev R.","family":"Amin","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, 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