"Close Then Clear" Margins in Transoral Resection of p16+ Oropharyngeal Squamous Cell Carcinoma.

[OBJECTIVE] Standard 5-mm surgical margins in the oropharynx are challenging due to the intimate relationship with neurovascular structures and patient function. De-escalation of therapy with the acceptance of close surgical margins may improve functional patient outcomes. This study assesses locoregional recurrence with initial close (≤2 mm) margins following transoral surgery for p16+ oropharyngeal squamous cell carcinoma (SCC) with or without re-resection and adjuvant therapy.

[STUDY DESIGN] Retrospective cohort study.

[SETTING] Canadian tertiary care center.

[METHODS] Retrospective chart review of all patients who underwent transoral robotic surgery or transoral laser microsurgery with curative intent for p16+ oropharyngeal SCC and had ≤2 mm initial surgical margins with or without re-resection and adjuvant therapy between January 2019 and December 2023. The primary outcome was 2-year locoregional control.

[RESULTS] In total, 80 patients were included; 54 had a 2-year follow-up available. Initial margins were close (≤2 mm) in 44 patients (55%) and positive in 34 patients (42.5%). Re-resection was performed in 67 patients (83.8%). Following re-resections, three patients (3.8%) had positive margins and 77 (96.2%) had close or clear margins. Deep margins were most involved (67.5%). In total, 42 patients (52.5%) received adjuvant (chemo)-radiotherapy. Amongst the 54 patients eligible for 2-year follow-up, one had regional recurrence at 18 months postsurgery, resulting in a 2-year locoregional control rate of 98.1%.

[CONCLUSION] p16+ oropharyngeal SCC with close initial surgical margins results in low locoregional recurrence rates. Intraoperative re-resection with acceptance of close surgical margins may be an effective strategy to preserve both oncologic safety and functional outcomes.