{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T14:41:19Z","timestamp":1788273679626,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T00:00:00Z","timestamp":1557100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Purpose of the study is to assess nationwide margin performance in oropharynx transoral robotic surgery (TORS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective review of the National Cancer Database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Two thousand six hundred sixty\u2010one patients were included. The national positive margin rate (PMR) was 16.9%. High\u2010volume facilities had a lower PMR than low\u2010volume facilities (12.7% vs 21.9%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;\u2009.001). Patients with disease of the tonsil had a lower PMR (15.7%) than base\u2010of\u2010the\u2010tongue (18.2%;\n                      <jats:italic>P<\/jats:italic>\n                      =\u2009.14). PMR increased with T classification (T1 = 13.0%, T2 = 17.1%, T3 = 28.2%, T4a = 45.9%, T4b = 58.3%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;\u2009.001). On multivariable regression, factors associated with margin status included only lymph\u2010vascular invasion (1.63[1.13\u20102.36];\n                      <jats:italic>P<\/jats:italic>\n                      =\u2009.01), high volume (0.57[0.36\u20100.92];\n                      <jats:italic>P<\/jats:italic>\n                      =\u2009.005), and T classification (as compared to T1, T2: 1.50[1.03\u20102.18], T3: 3.11[1.77\u20105.46], T4a: 7.03[2.95\u201016.75], T4b: 6.72[1.26\u201035.93];\n                      <jats:italic>P<\/jats:italic>\n                      &lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>National PMR is 16.9%, substantially higher than reported in high\u2010volume TORS centers. There is a linear association between positive margins and T classification, with T3 and T4 PMRs exceeding 28%. High\u2010volume facilities are half as likely to yield positive margins compared to low\u2010volume facilities. There was no association between human papilloma virus status, tumor subsite, or academic facility status and positive margins.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.25792","type":"journal-article","created":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T17:07:44Z","timestamp":1557162464000},"page":"3064-3072","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Positive margin rates and predictors in transoral robotic surgery after federal approval: A national quality study"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0339-7050","authenticated-orcid":false,"given":"Jonathan","family":"Hanna","sequence":"first","affiliation":[{"name":"Department of Surgery, Section of Otolaryngology Yale University School of Medicine  New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8893-805X","authenticated-orcid":false,"given":"Elliot","family":"Morse","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Otolaryngology Yale University School of Medicine  New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip R.","family":"Brauer","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Otolaryngology Yale University School of Medicine  New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Judson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Otolaryngology Yale\u2010New Haven Hospital, Yale Cancer Center, Yale University School of Medicine  New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saral","family":"Mehra","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Otolaryngology Yale\u2010New Haven Hospital, Yale Cancer Center, Yale University School of Medicine  New Haven Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,5,6]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/014556130508400315"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.14908"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599814525747"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2016.4634"},{"key":"e_1_2_6_6_1","unstructured":"US Food and Drug Administration. 501 (k) summary Section III: indications for use for intuitive surgical endoscopic instrument control system for transoral otolaryngology procedures. 2009."},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599812437534"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.133.12.1220"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2015.1508"},{"issue":"12","key":"e_1_2_6_10_1","first-page":"CD010963","article-title":"Minimally invasive surgery versus radiotherapy\/chemoradiotherapy for small\u2010volume primary oropharyngeal carcinoma","volume":"12","author":"Howard J","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23995"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2011.10.007"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.5041\/RMMJ.10150"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(76)90314-7"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-016-4433-3"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27740"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.62.3157"},{"key":"e_1_2_6_18_1","unstructured":"American College of Surgeons.National Cancer Database.https:\/\/www.facs.org\/quality\u2010programs\/cancer\/ncdb. 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