[Transoral robotic surgery in head and neck cancers]

Transoral robotic surgery (TORS) for head and neck cancers has developed since 2005, following the pioneering work of the University of Pennsylvania team. Since then, numerous publications have demonstrated its clinical feasibility and safety, while several clinical trials have confirmed favorable oncologic and functional outcomes. Today, robotic surgery is routinely used as an alternative to conventional transoral approaches for tumors that are difficult to expose, as an alternative to external open approaches for tumors that are not amenable to transoral exposure, and as an alternative to non-surgical treatments when robotic surgery is expected to provide oncologic or quality-of-life benefits. The most common head and neck tumor sites treated with robotic surgery are HPV-positive oropharyngeal carcinomas, followed by HPV-negative oropharyngeal carcinomas, supraglottic laryngeal tumors, and other less frequent locations. In oropharyngeal carcinoma, published data have demonstrated oncologic outcomes at least equivalent to those achieved with other therapeutic and surgical strategies, while allowing de-escalation of adjuvant treatments in patients with low- or intermediate-risk disease. Evidence remains more limited for other tumor sites, particularly the larynx, hypopharynx, parapharyngeal spaces, and salvage surgery, where robotic surgery may be reserved for carefully selected indications and patients and performed by experienced teams. This article summarizes the current evidence regarding indications, oncologic and functional outcomes, and future perspectives of robotic surgery within the framework of personalized multimodal treatment strategies.