(636) Outcomes after transoral robotic surgery for minor salivary gland cancer: A database study

Introduction: Transoral robotic surgery (TORS) was first FDA approved for the treatment of early (T1 and T2) head and neck tumors in 2009. Its benefit has been well described for oropharyngeal squamous cell carcinoma, but limited evidence exists for its use in minor salivary gland (MSG) cancers, though limited series have shown favorable results. To our knowledge, this is the first large, multi-institutional database study to describe oncologic, surgical, and specific functional outcomes following TORS for the treatment of MSG cancers.

Methods: The TriNetX database was searched for all patients ages 18-90 with “minor salivary gland cancer” undergoing “robotic head and neck surgery.” Primary outcomes were one-, three-, and five-year overall survival (OS). Secondary outcomes included 90-day rates of tracheostomy, gastrostomy, and overall complications. Descriptive statistics were used in analysis of the overall cohort, functional outcomes, and complication rates. Kaplan-Meier analysis was used to assess survival after TORS. Propensity score matching was used to assess the effect of neck dissection and adjuvant therapy on 5-year OS after TORS.

Results: 611 patients with MSG cancer undergoing TORS from 45 health care organizations were identified from 2010-2025. The mean age at the time of TORS was 62.1 years (SD +/-10.2 years). Most patients were male (72.5%), Caucasian (82%), and not Hispanic/Latino (81.18%). Neck dissection was performed in 365 (59.74%). Adjuvant therapy was performed in 149 (24.39%). The 90-day mortality, complication, tracheostomy, and gastrostomy rates were < 1.64%, 8.00%, 3.75%, and 10.65%. One-year, three-year, and five-year OS rates were 95.46%, 82.97%, and 77.27%. After propensity score matching, adjuvant therapy and neck dissection were not associated with long-term tracheostomy and gastrostomy rates, nor with improved survival.

Conclusions: Treatment of MSG cancer with TORS was associated with few complications and excellent functional outcomes. These results suggest that TORS may be a safer, less morbid alternative to the traditional open approaches for MSG tumor resection.