A comparative analysis of transoral laser microsurgery and transoral robotic surgery for the treatment of oropharyngeal squamous cell carcinoma.

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.