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Scientific Oral Presentation

Head and Neck Surgery

Redefining Close Margins in Transoral Robotic Surgery for Hpv-associated Oropharyngeal Cancer

Monday, October 19, 2026
1:06 PM - 1:12 PM PT
Location: West Exhibit Hall A, Learning Zone 3

    Presenting Author(s)

  • Austin C. Cao, MD

    Resident Physician
    University of Pennsylvania School of Medicine
    Philadelphia, Pennsylvania, United States

    • Co-Author(s)

  • KR

    Karthik Rajasekaran, MD

    Associate Professor of Otorhinolaryngology
    University of Pennsylvania
    Philadelphia, PA, United States

  • GW

    Gregory S. Weinstein, MD

    Professor of Otorhinolaryngology
    University of Pennsylvania
    Philadelphia , PA, United States

  • Ryan M. Carey, MD

    Associate Professor of Otorhinolaryngology
    Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania Health System
    Philadelphia, Pennsylvania, United States

    • Senior Author(s)

  • Robert M. Brody, MD

    Associate Professor of Otorhinolaryngology
    University of Pennsylvania
    Philadelphia, Pennsylvania, United States

Introduction: Current guidelines define close surgical margins in HPV-associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) broadly as 1-3 mm, yet optimal margin thresholds to guide adjuvant therapy de-escalation remain unclear. This study evaluates oncologic outcomes across distinct margin categories in patients undergoing transoral robotic surgery (TORS) for HPV+ OPSCC.

Methods: This retrospective cohort study analyzed 1,306 patients who underwent primary TORS for HPV+ OPSCC. Patients were stratified into five margin categories: negative, close 1-2 mm, close < 1 mm, positive, and carcinoma in situ present at margin. Primary outcome measures included overall survival (OS) and time to recurrence (TTR), analyzed using Kaplan-Meier survival curves, pairwise log-rank tests with Benjamini-Hochberg adjustment, and Cox proportional hazards regression. Patient and treatment characteristics were compared across margin groups with Fischer’s exact test.

Results: Close margins 1-2 mm demonstrated equivalent OS (Hazard ratio=1.00, p-value=0.99) and TTR (HR=1.02, p=0.90) when compared to negative margins. These groups had similar rates of adjuvant chemotherapy (28%) at our institution. However, close margins < 1 mm have significantly worse OS (HR=1.56, p=0.03) and TTR (HR=1.59, p=0.04) when compared to 1-2 mm margins, with outcomes approximating the positive margin cohort. Close margins < 1 mm and positive margins were associated with advanced T-stage, advanced N-stage, LVI, and PNI. Patient demographics were not significantly different across groups.

Conclusions: A critical threshold exists at 1 mm for surgical margins in HPV+ OPSCC. Margins between 1-2 mm and true negative margins were comparable in both rates of adjuvant therapy received and long-term oncologic outcomes. These findings support consideration for de-escalation of adjuvant therapy for patients with a previously defined close margin between 1-2 mm after TORS.