Abstract
BACKGROUND: The rate of primary surgery for human papillomavirus (HPV)-related oropharynx cancer has recently declined, whereas use of transoral robotic surgery has lagged at community cancer centers. We hypothesize that differences in overall survival exist between patients undergoing surgery for HPV-related oropharynx cancer at community centers and low transoral robotic surgery volume (<15 transoral robotic surgeries per year) academic centers and high transoral robotic surgery volume (≥15 transoral robotic surgeries per year) academic centers. METHODS: Patients from the US National Cancer Database with a diagnosis of HPV-related oropharynx cancer from 2010 to 2019 who underwent primary surgical treatment were included. Trends in transoral robotic surgery use, rates of positive surgical margins, quality of adjuvant treatment, and 5-year overall survival were compared between community centers, low transoral robotic surgery volume academic centers, and high transoral robotic surgery volume academic centers. RESULTS: A total of 5406 patients met study criteria. A clinically and statistically significantly lower proportion of patients at community centers underwent transoral robotic surgery than at low transoral robotic surgery volume academic centers or high transoral robotic surgery volume academic centers (26.2% vs 44.0% vs 73.9%, respectively; P < .001). The rate of positive surgical margins was clinically and statistically significantly higher at community centers than at low transoral robotic surgery volume academic centers or high transoral robotic surgery volume academic centers (25.7% vs 15.3% vs 9.2%, respectively; P < .001). A greater proportion of patients undergoing adjuvant radiotherapy (RT) received prolonged courses (23.6% vs 13.1% vs 8.8%; P < .001) or excessive doses (16.5% vs 11.5% vs 8.7%; P < .001) of RT at community centers than at low transoral robotic surgery volume academic centers or high transoral robotic surgery volume academic centers, respectively. Five-year overall survival was lowest at community centers (85.2%, 95% confidence interval [CI] = 81.7% to 88.2%), intermediate at low transoral robotic surgery volume academic centers (88.9%, 95% CI = 87.2% to 90.4%), and highest at high transoral robotic surgery volume academic centers (91.4%, 95% CI = 89.5% to 92.9%; Plog-rank < .01). CONCLUSIONS: Clinically and statistically significant differences in the type and quality of surgical and adjuvant treatment for HPV-related oropharynx cancer exist between facility types based on transoral robotic surgery volume. Overall survival was lowest at community centers, intermediate at low transoral robotic surgery volume academic centers, and highest at high transoral robotic surgery volume academic centers.