Transoral Surgery versus Primary Chemoradiation for Advanced Stage Head and Neck Squamous Cell Carcinoma

Objectives:Compare functional and survival outcomes between patients with advanced stage head and neck squamous cell cancer (HNSCC) treated with primary transoral surgery versus primary chemotherapy and radiation.Methods:Retrospective case-control trial at an academic tertiary referral center. We identified a surgical group (SG) comprised of 37 patients with previously untreated stage III and IV HNSCC who underwent either transoral robotic surgery (TORS) or transoral laser microsurgery (TLMS) and a nonsurgical group (NSG) of 75 patients treated with primary chemotherapy and radiation between July 2007 and November 2011. NSG was matched to SG by age, sex, tumor location, stage, tobacco and alcohol use, and ECOG status. Tracheostomy and percutaneous gastrostomy tube (PEG) rates during treatment and at follow-up, as well as survival outcomes, were examined.Results:There were no statistically significant differences in the matched variables. Significantly fewer patients in the SG compared with the NSG still h...