European TORS Guidelines for Head and Neck Cancer | HN Oncology Journal Club Ep 006

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First comprehensive European surgical practice guidelines for transoral robotic surgery (TORS) in head and neck cancer management.

Paper: Lechien JR, Paleri V, et al. European surgical guidelines: transoral robotic surgery for head and neck cancers. Oral Oncology 2026.

Full episode & newsletter: https://hnoncology-journalclub.netlify.app/episode-006.html

METHODOLOGY
- 22 experts from 11 European countries
- Modified Delphi consensus process
- Average 17.8 years clinical experience, 164.7 TORS procedures per panelist
- Endorsed by EHNS, ELS, and YO-IFOS

TORS INDICATIONS BY SITE

Oropharyngeal Cancer:
- cT1-T2 and selected cT3 tumors
- Particularly appropriate for HPV+ disease (de-escalation potential)
- 3mm margins now validated for HPV+ tumors

Supraglottic Laryngeal Cancer:
- cT1-T2 tumors of epiglottis, aryepiglottic fold, false vocal cords
- Selected cT3 with pre-epiglottic invasion if 1cm or greater margin from hyoid achievable

Hypopharyngeal Cancer:
- cT1-T2 tumors above horizontal cricoid plane

KEY CONTRAINDICATIONS
- Carotid artery invasion
- Resection requiring more than 50% tongue musculature
- Bilateral lingual artery ligation required
- cT4 disease at any site

POSTOPERATIVE CARE
- Tracheostomy and feeding tube NOT mandatory for all cases
- 24-hour ICU/recovery monitoring recommended
- IV corticosteroids may reduce edema and pain

BOTTOM LINE
These guidelines standardize TORS patient selection and validate less morbid approaches — including 3mm margins for HPV+ disease and avoidance of routine tracheostomy.

Paper: https://doi.org/10.1016/j.oraloncology.2025.107826

#TORS #TransoralRoboticSurgery #HeadAndNeckCancer #OropharyngealCancer #LaryngealCancer #RoboticSurgery #SurgicalOncology #HPV #MedicalEducation #Oncology
Categoria
Oncology
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