Positive Deep Initial Incision Margin Affects Outcomes in TORS for HPV+ Oropharynx Cancer

Alexandra Kejner, Christopher Gentile, Zachary Porterfield, William R. Carroll, Erin Partington Buczek

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: Evaluate the effect of initial incision margins (IIM) on clinical outcomes after transoral robotic surgery (TORS) for human papillomavirus positive (HPV+) squamous cell cancers of the oropharynx (OPSCC). Methods: Retrospective chart review of patients undergoing TORS for HPV+ OPSCC from 2007 to 2015 was performed. Overall survival (OS), disease-specific survival (DSS), recurrence, and metastases were evaluated in the context of pathology, IIM, final margins, adjuvant therapy, and patient characteristics. Results: Ninety-five patients with HPV+ OPSCC undergoing primary surgery were identified. 88% of these patients had no evidence of disease at the conclusion of the study (average follow-up 45 months). Twenty were identified that had true positive IIM and 16 had very close IIM, with the remainder demonstrating widely negative margins. Tumor very close to or involving the deep margin but not a mucosal margin was associated with a higher risk of recurrence. Perineural invasion and lymphovascular invasion were associated with positive IIM. Positive or very close IIM on the deep margin was found to impact DSS and recurrence. Conclusion: Obtaining negative IIM while performing TORS for HPV+ OPSCC is a modifiable factor that affects recurrence and DSS. Larger surgical margins should be considered in patients with perineural invasion or whose tumor abuts the initial deep margin. Level of Evidence: 4 Laryngoscope, 133:1132–1137, 2023.

Original languageEnglish
Pages (from-to)1132-1137
Number of pages6
Issue number5
StatePublished - May 2023

Bibliographical note

Funding Information:
Partial support for this manuscript was provided by the Fogarty International Center Global Health Equity Scholars Program of the National Institute of Health award number D43TW010540 to Dr. J. Zachary Porterfield.

Publisher Copyright:
© 2022 The American Laryngological, Rhinological and Otological Society, Inc.


  • HPV
  • cut-through margins
  • head and neck cancer
  • margin status
  • transoral robotic surgery

ASJC Scopus subject areas

  • Otorhinolaryngology


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