{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T21:08:59Z","timestamp":1791493739763,"version":"4.3.4"},"reference-count":109,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T00:00:00Z","timestamp":1675728000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: to describe current scientific knowledge regarding the treatment options in advanced oropharyngeal cancer. The standard care for advanced oropharyngeal cancer (OPSCC) has been chemoradiotherapy, although surgical approaches followed by adjuvant treatment have been proposed. The best therapy for each patient should be decided by an interdisciplinary tumour-board. Different strategies should be considered for the specific patient\u2019s treatment: surgery, chemotherapy and radiation therapy or combinations of them. The treatment choice is influenced by tumour variability and prognostic factors, but it also depends on cancer extension, extranodal extension, nervous invasion, human papilloma virus (HPV) presence, making the decisional algorithm not always clear. HPV-related OPSCC is strongly associated with a favourable overall survival (OS) and disease-free survival rate (DSS); by contrast, HPV-negative OPSCC often flags a worse prognosis. Consequently, the American Joint Committee on Cancer (AJCC) differentiates OPSCC treatment and prognosis based on HPV status. Methods: we carried out a review of current scientific literature to analyze the different indications and limitations of surgical treatment options in OPSCC stage III and IV. Conclusion: robotic surgery or open approaches with reconstructive flaps can be considered in advanced stages, resulting in the de-intensification of subsequent systemic therapy and fewer related side effects. Furthermore, in the event of the primary failure of systemic therapy or disease recurrence, the surgical approach constitutes an additional therapeutic option which lengthens patient survival functions.<\/jats:p>","DOI":"10.3390\/medicina59020304","type":"journal-article","created":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T03:01:45Z","timestamp":1675825305000},"page":"304","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Surgical Treatment for Advanced Oropharyngeal Cancer: A Narrative Review"],"prefix":"10.3390","volume":"59","author":[{"given":"Antonino","family":"Maniaci","sequence":"first","affiliation":[{"name":"Department of Medical, Surgical and Advanced Technologies G.F.Ingrassia, ENT Section, University of Catania, 95123 Catania, Italy"},{"name":"Facult\u00e9 des Sciences M\u00e9dicales et Param\u00e9dicales, Aix-Marseille Universit\u00e9, 13005 Marseille, France"},{"name":"P\u00f4le PROMO, Service ORL et Chirurgie Cervico-Faciale, H\u00f4pital de la Conception, Assistance Publique des H\u00f4pitaux de Marseille, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Po","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, School of Medicine, Fu-Jen University, Taipei 100, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Cancemi","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgical and Advanced Technologies G.F.Ingrassia, ENT Section, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1827-0626","authenticated-orcid":false,"given":"Damiano","family":"Giardini","sequence":"additional","affiliation":[{"name":"Department of Surgery, ENT Unit, \u201cSanta Maria delle Croci\u201d Hospital, 48121 Ravenna, Italy"},{"name":"\u201cUmberto I\u201d Hospital, Health Local Agency of Romagna, 48022 Lugo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Checcoli","sequence":"additional","affiliation":[{"name":"Department of Surgery, ENT Unit, \u201cSanta Maria delle Croci\u201d Hospital, 48121 Ravenna, Italy"},{"name":"\u201cUmberto I\u201d Hospital, Health Local Agency of Romagna, 48022 Lugo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Soprani","sequence":"additional","affiliation":[{"name":"Department of Surgery, ENT Unit, \u201cSanta Maria delle Croci\u201d Hospital, 48121 Ravenna, Italy"},{"name":"\u201cUmberto I\u201d Hospital, Health Local Agency of Romagna, 48022 Lugo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1781-2809","authenticated-orcid":false,"given":"Giannicola","family":"Iannella","sequence":"additional","affiliation":[{"name":"Department of Surgery, ENT Unit, \u201cMorgagni-Pierantoni\u201d Hospital, 47121 Forl\u00ec, Italy"},{"name":"\u201cDegli Infermi\u201d Hospital, Health Local Agency of Romagna, 48018 Faenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Vicini","sequence":"additional","affiliation":[{"name":"Department of Surgery, ENT Unit, \u201cMorgagni-Pierantoni\u201d Hospital, 47121 Forl\u00ec, Italy"},{"name":"\u201cDegli Infermi\u201d Hospital, Health Local Agency of Romagna, 48018 Faenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6135-0958","authenticated-orcid":false,"given":"Salvatore","family":"Cocuzza","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgical and Advanced Technologies G.F.Ingrassia, ENT Section, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignazio","family":"La Mantia","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgical and Advanced Technologies G.F.Ingrassia, ENT Section, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7070-0780","authenticated-orcid":false,"given":"Nicolas","family":"Fakhry","sequence":"additional","affiliation":[{"name":"Facult\u00e9 des Sciences M\u00e9dicales et Param\u00e9dicales, Aix-Marseille Universit\u00e9, 13005 Marseille, France"},{"name":"P\u00f4le PROMO, Service ORL et Chirurgie Cervico-Faciale, H\u00f4pital de la Conception, Assistance Publique des H\u00f4pitaux de Marseille, 13005 Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9802-7716","authenticated-orcid":false,"given":"Andrea","family":"De Vito","sequence":"additional","affiliation":[{"name":"Department of Surgery, ENT Unit, \u201cSanta Maria delle Croci\u201d Hospital, 48121 Ravenna, Italy"},{"name":"\u201cUmberto I\u201d Hospital, Health Local Agency of Romagna, 48022 Lugo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1002\/ijc.31937","article-title":"Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods","volume":"144","author":"Ferlay","year":"2019","journal-title":"Int. J. Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.oraloncology.2015.01.017","article-title":"Response evaluation after chemoradiotherapy for advanced nodal disease in head and neck cancer using diffusion-weighted MRI and 18F-FDG-PET-CT","volume":"51","author":"Schouten","year":"2015","journal-title":"Oral Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/S1473-3099(18)30802-8","article-title":"Gender-neutral HPV vaccination in the UK, rising male oropharyngeal cancer rates, and lack of HPV awareness","volume":"19","author":"Lechner","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1002\/cncr.31841","article-title":"The prevalence of human papillomavirus in oropharyngeal cancer is increasing regardless of sex or race, and the influence of sex and race on survival is modified by human papillomavirus tumor status","volume":"125","author":"Faraji","year":"2019","journal-title":"Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"93","DOI":"10.3322\/caac.21388","article-title":"The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more \u201cpersonalized\u201d approach to cancer staging","volume":"67","author":"Amin","year":"2017","journal-title":"CA Cancer J. Clin."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1080\/21505594.2014.999570","article-title":"HPV and cancer of the oral cavity","volume":"6","year":"2015","journal-title":"Virulence"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1038\/bjc.2015.139","article-title":"Different prognostic models for different patient populations: Validation of a new prognostic model for patients with oropharyngeal cancer in Western Europe","volume":"112","author":"Rietbergen","year":"2015","journal-title":"Br. J. Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1097\/PAS.0b013e3182116a45","article-title":"Isolating p16-positive\/HPV-negative oropharyngeal cancer: An effort worth making","volume":"35","author":"Perrone","year":"2011","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1056\/NEJMoa0912217","article-title":"Human papillomavirus and survival of patients with oropharyngeal cancer","volume":"363","author":"Ang","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Carlander, A.F., Jakobsen, K.K., Bendtsen, S.K., Garset-Zamani, M., Lynggaard, C.D., Jensen, J.S., Gr\u00f8nh\u00f8j, C., and von Buchwald, C. (2021). A contemporary systematic review on repartition of HPV-positivity in oropharyngeal cancer worldwide. Viruses, 13.","DOI":"10.3390\/v13071326"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4411","DOI":"10.1245\/s10434-015-4525-0","article-title":"Detailed Analysis of Clinicopathologic Factors Demonstrate Distinct Difference in Outcome and Prognostic Factors Between Surgically Treated HPV-Positive and Negative Oropharyngeal Cancer","volume":"22","author":"Iyer","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.amjoto.2019.05.006","article-title":"The prognostic effect of anatomic subsite in HPV-positive oropharyngeal squamous cell carcinoma","volume":"40","author":"Tham","year":"2019","journal-title":"Am. J. Otolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1007\/s00432-014-1631-5","article-title":"Surgically treated oropharyngeal cancer: Risk factors and tumor characteristics","volume":"140","author":"Baumeister","year":"2014","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1007\/s12094-020-02467-8","article-title":"Long-term outcomes of induction chemotherapy followed by chemoradiotherapy vs chemoradiotherapy alone as treatment of unresectable head and neck cancer: Follow-up of the Spanish Head and Neck Cancer Group (TTCC) 2503 Trial","volume":"23","author":"Hitt","year":"2020","journal-title":"Clin. Transl. Oncol."},{"key":"ref_15","first-page":"35","article-title":"Feasibility and efficacy of chemoradiotherapy with concurrent split-dose cisplatin after induction chemotherapy with docetaxel\/cisplatin\/5-fluorouracil for locally advanced head and neck cancer","volume":"13","author":"Yokota","year":"2020","journal-title":"Mol. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"559","DOI":"10.4103\/jcrt.JCRT_702_18","article-title":"Metronomic palliative chemotherapy in locally advanced, recurrent and metastatic head-and-neck cancer: A single-arm, retrospective study of a regional cancer center of North India (Asia)","volume":"16","author":"Harsh","year":"2020","journal-title":"J. Cancer Res. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.pvr.2018.09.002","article-title":"Long-term survival and swallowing outcomes in advanced stage oropharyngeal squamous cell carcinomas","volume":"7","author":"Clark","year":"2019","journal-title":"Papillomavirus Res."},{"key":"ref_18","first-page":"Cd012939","article-title":"De-intensified adjuvant (chemo)radiotherapy versus standard adjuvant chemoradiotherapy post transoral minimally invasive surgery for resectable HPV-positive oropharyngeal carcinoma","volume":"12","author":"Howard","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1016\/S1470-2045(20)30327-2","article-title":"Debio 1143 and high-dose cisplatin chemoradiotherapy in high-risk locoregionally advanced squamous cell carcinoma of the head and neck: A double-blind, multicentre, randomised, phase 2 study","volume":"21","author":"Sun","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e1213","DOI":"10.1016\/S2214-109X(20)30275-8","article-title":"Low-cost oral metronomic chemotherapy versus intravenous cisplatin in patients with recurrent, metastatic, inoperable head and neck carcinoma: An open-label, parallel-group, non-inferiority, randomised, phase 3 trial","volume":"8","author":"Patil","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3323","DOI":"10.2147\/CMAR.S248392","article-title":"Nimotuzumab Combined with Induction Chemotherapy and Concurrent Chemoradiotherapy in Unresectable Locally Advanced Hypopharyngeal Carcinoma: A Single Institution Experience in China","volume":"12","author":"Tian","year":"2020","journal-title":"Cancer Manag. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1001\/jamaoto.2015.0764","article-title":"Treatment Outcomes for T4 Oropharyngeal Squamous Cell Carcinoma","volume":"141","author":"Zenga","year":"2015","journal-title":"JAMA Otolaryngol. Neck Surg."},{"key":"ref_23","first-page":"49","article-title":"Narrow band imaging: A new tool for evaluation of head and neck squamous cell carcinomas. Review of the literature","volume":"28","author":"Piazza","year":"2008","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s11912-015-0498-1","article-title":"The Role of Narrow Band Imaging in Head and Neck Cancers","volume":"18","author":"Ni","year":"2016","journal-title":"Curr. Oncol. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s10043-003-0211-8","article-title":"Endoscopic observation of tissue by narrowband illumination","volume":"10","author":"Gono","year":"2003","journal-title":"Opt. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/j.oraloncology.2011.02.012","article-title":"Nasopharyngeal carcinoma detected by narrow-band imaging endoscopy","volume":"47","author":"Wang","year":"2011","journal-title":"Oral Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1007\/s00405-008-0835-1","article-title":"The value of narrow band imaging for early detection of laryngeal cancer","volume":"266","author":"Watanabe","year":"2009","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1111\/coa.12728","article-title":"Narrow band imaging as screening test for early detection of laryngeal cancer: A prospective study","volume":"42","author":"Meccariello","year":"2017","journal-title":"Clin. Otolaryngol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2430","DOI":"10.1002\/hed.25724","article-title":"Validity of narrow band imaging in the detection of oral and oropharyngeal malignant lesions: A systematic review and meta-analysis","volume":"41","author":"Ansari","year":"2019","journal-title":"Head Neck"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1002\/lary.21553","article-title":"Diagnosis of the extent of advanced oropharyngeal and hypopharyngeal cancers by narrow band imaging with magnifying endoscopy","volume":"121","author":"Matsuba","year":"2011","journal-title":"Laryngoscope"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3347","DOI":"10.1007\/s00405-016-3925-5","article-title":"The diagnostic value of narrow band imaging in different oral and oropharyngeal subsites","volume":"273","author":"Piazza","year":"2016","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.amjoto.2016.09.020","article-title":"NBI utility in the pre-operative and intra-operative assessment of oral cavity and oropharyngeal carcinoma","volume":"38","author":"Tirelli","year":"2017","journal-title":"Am. J. Otolaryngol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1810","DOI":"10.1002\/lary.27567","article-title":"Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer","volume":"129","author":"Tirelli","year":"2019","journal-title":"Laryngoscope"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.oraloncology.2016.07.001","article-title":"The diagnostic performance parameters of narrow band imaging: A preclinical and clinical study","volume":"60","author":"Ottaviani","year":"2016","journal-title":"Oral Oncol."},{"key":"ref_35","first-page":"157","article-title":"A novel approach emphasising intra-operative superficial margin enhancement of head-neck tumours with narrow-band imaging in transoral robotic surgery","volume":"35","author":"Vicini","year":"2015","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"75","DOI":"10.14639\/0392-100X-2199","article-title":"Trans-oral robotic surgery for the management of oropharyngeal carcinomas: A 9-year institutional experience","volume":"39","author":"Meccariello","year":"2019","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1007\/s00405-015-3698-2","article-title":"Enhanced contact endoscopy for the assessment of the neoangiogenetic changes in precancerous and cancerous lesions of the oral cavity and oropharynx","volume":"273","author":"Carta","year":"2016","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.soc.2015.03.012","article-title":"Imaging for head and neck cancer","volume":"24","author":"Abraham","year":"2015","journal-title":"Surg. Oncol. Clin. N. Am."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1148\/rg.312105107","article-title":"Oral cavity and oropharyngeal squamous cell cancer: Key imaging findings for staging and treatment planning","volume":"31","author":"Trotta","year":"2011","journal-title":"Radiographics"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Hodler, J., Kubik-Huch, R.A., and von Schulthess, G.K. (2020). Diseases of the Brain, Head and Neck, Spine 2020\u20132023: Diagnostic Imaging, Springer. Chapter 17.","DOI":"10.1007\/978-3-030-38490-6"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"327","DOI":"10.2967\/jnumed.119.230037","article-title":"Tumor Subregion Evolution-Based Imaging Features to Assess Early Response and Predict Prognosis in Oropharyngeal Cancer","volume":"61","author":"Wu","year":"2020","journal-title":"J. Nucl. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.oraloncology.2018.01.016","article-title":"Evaluating oropharyngeal carcinoma with transcervical ultrasound, CT, and MRI","volume":"78","author":"Faraji","year":"2018","journal-title":"Oral Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/01.cco.0000160276.78762.17","article-title":"18F-fluoro-2-deoxy-D-glucose positron emission tomographic imaging: Recent developments in head and neck cancer","volume":"17","author":"Muylle","year":"2005","journal-title":"Curr. Opin. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1097\/RLU.0000000000000255","article-title":"FDG PET\/CT imaging of oropharyngeal squamous cell carcinoma: Characteristics of human papillomavirus-positive and -negative tumors","volume":"39","author":"Tahari","year":"2014","journal-title":"Clin. Nucl. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"388","DOI":"10.3389\/fonc.2019.00388","article-title":"Current Role of Surgery in the Management of Oropharyngeal Cancer","volume":"9","year":"2019","journal-title":"Front. Oncol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1177\/0194599814542939","article-title":"Transoral robotic versus open surgical approaches to oropharyngeal squamous cell carcinoma by human papillomavirus status","volume":"151","author":"Ford","year":"2014","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"4422","DOI":"10.1245\/s10434-015-4560-x","article-title":"A Contemporary Analysis of Surgical Trends in the Treatment of Squamous Cell Carcinoma of the Oropharynx from 1998 to 2012: A Report from the National Cancer Database","volume":"22","author":"Liederbach","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.mayocp.2011.10.007","article-title":"Long-term functional and oncologic results of transoral robotic surgery for oropharyngeal squamous cell carcinoma","volume":"87","author":"Moore","year":"2012","journal-title":"Mayo Clin. Proc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/j.ijrobp.2012.08.033","article-title":"Critical review: Transoral laser microsurgery and roboticassisted surgery for oropharynx cancer including human papilloma virusrelated cancer","volume":"85","author":"Moore","year":"2013","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s00405-014-2985-7","article-title":"Functional outcomes after TORS for oropharyngeal cancer, a systematic review","volume":"272","author":"Hutcheson","year":"2015","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_51","first-page":"945162","article-title":"The role of transoral robotic surgery in the management of oropharyngeal cancer: A review of the literature","volume":"2012","author":"Dowthwaite","year":"2012","journal-title":"ISRN Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.amjoto.2019.06.001","article-title":"Outcomes in surgically resectable oropharynx cancer treated with transoral robotic surgery versus definitive chemoradiation","volume":"40","author":"Dhanireddy","year":"2019","journal-title":"Am. J. Otolaryngol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"387","DOI":"10.4103\/ams.ams_33_18","article-title":"Comparison of TORS with Conventional Surgery for Oropharyngeal Carcinomas in T1-T4 Lesions","volume":"9","author":"Gangwani","year":"2019","journal-title":"Ann. Maxillofac. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"104889","DOI":"10.1016\/j.oraloncology.2020.104889","article-title":"Trans oral robotic surgery versus definitive chemoradiotherapy for oropharyngeal cancer: 10-year institutional experience","volume":"110","author":"Meccariello","year":"2020","journal-title":"Oral Oncol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s11912-020-00948-1","article-title":"Present and Future of De-intensification Strategies in the Treatment of Oropharyngeal Carcinoma","volume":"22","author":"Costantino","year":"2020","journal-title":"Curr. Oncol. Rep."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1001\/jamaoto.2016.3353","article-title":"The Role of Adjuvant Chemotherapy in Surgically Managed, p16-Positive Oropharyngeal Squamous Cell Carcinoma","volume":"9","author":"Skillington","year":"2017","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.anl.2020.09.002","article-title":"Second postoperative hemorrhage five weeks after transoral robotic surgery","volume":"49","author":"Tsukahara","year":"2020","journal-title":"Auris Nasus Larynx"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1159\/000320596","article-title":"Transoral robotic surgery for parapharyngeal space tumors","volume":"72","author":"Quon","year":"2010","journal-title":"J. Oto-Rhino-Laryngol. Its Relat. Spec."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1007\/s12094-019-02256-y","article-title":"Transoral robotic surgery for squamous cell carcinoma of the oropharynx in a primarily human papillomavirus-negative patient population","volume":"22","author":"Porcuna","year":"2020","journal-title":"Clin. Transl. Oncol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"105140","DOI":"10.1016\/j.oraloncology.2020.105140","article-title":"Thomson DJ Improved survival prediction for oropharyngeal cancer beyond TNMv8","volume":"115","author":"Price","year":"2021","journal-title":"Oral Oncol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"129","DOI":"10.3389\/fonc.2017.00129","article-title":"Prognostic Impact of AJCC\/UICC 8th Edition New Staging Rules in Oropharyngeal Squamous Cell Carcinoma","volume":"7","author":"Wagner","year":"2017","journal-title":"Front. Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.ijrobp.2010.01.032","article-title":"Matched survival analysis in patients with locoregionally advanced resectable oropharyngeal carcinoma: Platinum-based induction and concurrent chemoradiotherapy versus primary surgical resection","volume":"80","author":"Gava","year":"2011","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Sommerfeld, C., Jeffery, C., Clark, J.M., O\u2019Connell, D., Harris, J., and Seikaly, H. (2019). Transoral Robotic Surgery Versus Chemoradiation Treatment in Oropharyngeal Cancer: Case-matched Comparison of Survival and Swallowing Outcomes. Res. Sq.","DOI":"10.21203\/rs.2.13186\/v1"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/lary.28580","article-title":"Bleeding complications after transoral robotic surgery: A meta-analysis and systematic review","volume":"131","author":"Stokes","year":"2021","journal-title":"Laryngoscope"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"839","DOI":"10.2147\/CMAR.S118891","article-title":"Transoral robotic surgery for oropharyngeal cancer: Patient selection and special considerations","volume":"10","author":"Baskin","year":"2018","journal-title":"Cancer Manag. Res."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1177\/0003489417691297","article-title":"The Hybrid Transoral-Pharyngotomy Approach to Oropharyngeal Carcinoma: Technique and Outcome","volume":"126","author":"Sinha","year":"2017","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.radonc.2021.01.028","article-title":"Prevalence and distribution of cervical lymph node metastases in HPV-positive and HPV-negative oropharyngeal squamous cell carcinoma","volume":"157","author":"Bauwens","year":"2021","journal-title":"Radiother. Oncol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"4473","DOI":"10.1007\/s00520-020-05932-w","article-title":"The course of health-related quality of life from diagnosis to two years follow-up in patients with oropharyngeal cancer: Does HPV status matter?","volume":"29","author":"Korsten","year":"2021","journal-title":"Support Care Cancer"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e313","DOI":"10.1200\/OP.20.00671","article-title":"Socioeconomic Factors Influence the Impact of Tumor HPV Status on Outcome of Patients with Oropharyngeal Squamous Cell Carcinoma","volume":"17","author":"Marks","year":"2021","journal-title":"JCO Oncol. Pract."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.31557\/APJCP.2020.21.6.1679","article-title":"Characteristics and Impact of HPV-Associated p16 Expression on Head and Neck Squamous Cell Carcinoma in Thai Patients","volume":"21","author":"Jiarpinitnun","year":"2020","journal-title":"Asian Pac. J. Cancer Prev. APJCP"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.ejso.2020.07.034","article-title":"Upfront surgery or definitive radiotherapy for patients with p16-negative oropharyngeal squamous cell carcinoma. A GETTEC multicentric study","volume":"47","author":"Viotti","year":"2021","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"2137","DOI":"10.1016\/j.ejso.2019.06.027","article-title":"Oncological outcome following initiation of treatment for stage III and IV HPV negative oropharyngeal cancers with transoral robotic surgery (TORS)","volume":"45","author":"Dabas","year":"2019","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"de Almeida, J.R., Noel, C.W., Veigas, M., Martino, R., Chepeha, D.B., Bratman, S.V., Goldstein, D.P., Hansen, A.R., Yu, E., and Metser, U. (2019). Finding\/identifying primaries with neck disease (FIND) clinical trial protocol: A study integrating transoral robotic surgery, histopathological localisation and tailored deintensification of radiotherapy for unknown primary and small oropharyngeal head and neck squamous cell carcinoma. BMJ Open, 9.","DOI":"10.1136\/bmjopen-2019-035431"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1002\/hed.26477","article-title":"Human papillomavirus oropharynx carcinoma: Aggressive de-escalation of adjuvant therapy","volume":"43","author":"Moore","year":"2021","journal-title":"Head Neck"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1002\/hed.21500","article-title":"Transoral robotic surgery and human papillomavirus status: Oncologic results","volume":"33","author":"Cohen","year":"2011","journal-title":"Head Neck"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s11912-016-0541-x","article-title":"The Role of Transoral Robotic Surgery in the Management of HPV Negative Oropharyngeal Squamous Cell Carcinoma","volume":"18","author":"Sload","year":"2016","journal-title":"Curr. Oncol. Rep."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1001\/jamaoto.2015.1508","article-title":"Oncologic outcomes after transoral robotic surgery: A multi-institutional study","volume":"141","author":"Li","year":"2015","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"3152","DOI":"10.1002\/ijc.32412","article-title":"Identification of prognostic molecular biomarkers in 157 HPV-positive and HPV-negative squamous cell carcinomas of the oropharynx","volume":"145","author":"Dogan","year":"2019","journal-title":"Int. J. Cancer"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1002\/cncr.29323","article-title":"Surgical salvage improves overall survival for patients with HPV-positive and HPV-negative recurrent locoregional and distant metastatic oropharyngeal cancer","volume":"121","author":"Guo","year":"2015","journal-title":"Cancer"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S0360-3016(01)01690-X","article-title":"Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer","volume":"51","author":"Ang","year":"2001","journal-title":"Int. J. Radiat. Oncol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1002\/hed.20279","article-title":"Defining risk levels in locally advanced head and neck cancers: A comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (# 22931) and RTOG (# 9501)","volume":"27","author":"Bernier","year":"2005","journal-title":"Head Neck"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"6072","DOI":"10.1200\/JCO.2019.37.15_suppl.6072","article-title":"Phase II study: Induction chemotherapy and transoral surgery as definitive treatment (Tx) for locally advanced oropharyngeal squamous cell carcinoma (OPSCC)\u2014An update and retrospective review of non-study patients","volume":"37","author":"Siegel","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1002\/hed.26022","article-title":"Pathologic response to neoadjuvant chemotherapy in HPV-associated oropharynx cancer","volume":"42","author":"Sadeghi","year":"2020","journal-title":"Head Neck"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1200\/EDBK_280687","article-title":"Novel strategies to effectively de-escalate curative-intent therapy for patients with HPV-associated oropharyngeal cancer: Current and future directions","volume":"40","author":"Price","year":"2020","journal-title":"Am. Soc. Clin. Oncol. Educ. Book"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1002\/hed.27019","article-title":"Treatment de-escalation for HPV+ oropharyngeal cancer: A systematic review and meta-analysis","volume":"44","author":"Petrelli","year":"2022","journal-title":"Head Neck"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ctro.2019.06.005","article-title":"Chronic radiation-associated dysphagia in oropharyngeal cancer survivors: Towards age-adjusted dose constraints for deglutitive muscles","volume":"18","author":"Christopherson","year":"2019","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.1148\/rg.2019190007","article-title":"Advances in diagnosis and multidisciplinary management of oropharyngeal squamous cell carcinoma: State of the art","volume":"39","author":"Parvathaneni","year":"2019","journal-title":"Radiographics"},{"key":"ref_88","unstructured":"Ferris, R. (2021, March 25). Transoral Surgery Followed by Low-Dose or Standard-Dose Radiation Therapy with or Without Chemotherapy in Treating Patients with HPV Positive Stage III-IVA Oropharyngeal Cancer, Available online: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01898494."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/j.ijrobp.2019.11.341","article-title":"De-Escalated Adjuvant Therapy after Transoral Robotic Surgery for HPV related Oropharyngeal Carcinoma: The SiRS Trial","volume":"106","author":"Miles","year":"2020","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.21037\/atm-20-2984","article-title":"De-intensification strategies in HPV-related oropharyngeal squamous cell carcinoma\u2014A narrative review","volume":"8","author":"Strohl","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1001\/archotol.130.1.35","article-title":"Recurrent advanced (T3 or T4) head and neck squamous cell carcinoma: Is salvage possible?","volume":"130","author":"Gleich","year":"2004","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00005537-200003001-00001","article-title":"Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: When do the ends justify the means?","volume":"110","author":"Goodwin","year":"2000","journal-title":"Laryngoscope"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1002\/hed.20309","article-title":"Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer","volume":"28","author":"Ulbrich","year":"2006","journal-title":"Head Neck"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"5723","DOI":"10.1002\/cncr.24595","article-title":"The role of salvage surgery in patients with recurrent squamous cell carcinoma of the oropharynx","volume":"115","author":"Zafereo","year":"2009","journal-title":"Cancer"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"E658","DOI":"10.1002\/hed.24065","article-title":"Salvage surgery for locally recurrent oropharyngeal cancer","volume":"38","author":"Patel","year":"2016","journal-title":"Head Neck"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"E171","DOI":"10.1002\/lary.28083","article-title":"Practice patterns and outcomes following radiation dose de-escalation for oropharyngeal cancer","volume":"130","author":"White","year":"2020","journal-title":"Laryngoscope"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.oraloncology.2016.07.006","article-title":"Outcomes after surgical salvage for recurrent oropharyngeal squamous cell carcinoma","volume":"60","author":"Sweeny","year":"2016","journal-title":"Oral Oncol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1002\/hed.23637","article-title":"Algorithm to predict postoperative complications in oropharyngeal and oral cavity carcinoma","volume":"37","author":"Santoro","year":"2015","journal-title":"Head Neck"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"eAO4248","DOI":"10.1590\/s1679-45082018ao4248","article-title":"Oral and oropharyngeal cancer: Epidemiology and survival analysis","volume":"16","author":"Moro","year":"2018","journal-title":"Einstein"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"3132","DOI":"10.1002\/cncr.30712","article-title":"A prospective evaluation of short-term dysphagia after transoral robotic surgery for squamous cell carcinoma of the oropharynx","volume":"123","author":"Albergotti","year":"2017","journal-title":"Cancer"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.anl.2015.06.013","article-title":"Transoral surgery for laryngo-pharyngeal cancer\u2014The paradigm shift of the head and cancer treatment","volume":"43","author":"Tateya","year":"2016","journal-title":"Auris Nasus Larynx"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1097\/01.mlg.0000233244.18901.44","article-title":"Quality of life in advanced oropharyngeal carcinoma after chemoradiation versus surgery and radiation","volume":"116","author":"Mowry","year":"2006","journal-title":"Laryngoscope"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1001\/jamaoto.2013.2747","article-title":"Transoral robotic surgery for oropharyngeal cancer: Long-term quality of life and functional outcomes","volume":"139","author":"Dziegielewski","year":"2013","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1002\/lary.27856","article-title":"Predictors of swallow function after transoral surgery for locally advanced oropharyngeal cancer","volume":"130","author":"Gross","year":"2020","journal-title":"Laryngoscope"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1097\/00006534-200004050-00005","article-title":"Quality of life and disease-specific functional status following microvascular reconstruction for advanced (T3 and T4) oropharyngeal cancers","volume":"105","author":"Netscher","year":"2000","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1097\/00020840-199908000-00003","article-title":"The effect of head and neck reconstruction on quality of life","volume":"7","author":"Wax","year":"1999","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1007\/s00405-014-3331-9","article-title":"Understanding contraindications for transoral robotic surgery (TORS) for oropharyngeal cancer","volume":"271","author":"Weinstein","year":"2015","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1038\/s41416-020-0796-8","article-title":"Molecular subtypes of oropharyngeal cancer show distinct immune microenvironment related with immune checkpoint blockade response","volume":"122","author":"Kim","year":"2020","journal-title":"Br. J. Cancer"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1002\/cncr.30449","article-title":"Immunotherapy of head and neck cancer: Emerging clinical trials from a National Cancer Institute Head and Neck Cancer Steering Committee Planning Meeting","volume":"123","author":"Bauman","year":"2017","journal-title":"Cancer"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/2\/304\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:26:55Z","timestamp":1760120815000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/2\/304"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,7]]},"references-count":109,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["medicina59020304"],"URL":"https:\/\/doi.org\/10.3390\/medicina59020304","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,7]]}}}