Author(s)
Albert Y. Li, BA
Mishek Thapa, BS
Nathan Vu Pham, BS
Lavender Micalo, BS
Tyler J. Gallagher, MD MPH
Niels C. Kokot, MD
Affiliation(s)
Keck School of Medicine, University of Southern California, Los AngelesDavid Geffen School of Medicine, UCLA, Los Angeles, CADepartment of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to understand the comparative functional and survival outcomes of transoral robotic surgery (TORS) versus primary radiation therapy for early-stage laryngeal squamous cell carcinoma. Participants will be able to identify differences in postoperative morbidity, including dysphonia, dysphagia, and speech rehabilitation utilization, and apply this knowledge to optimize individualized treatment selection and shared decision-making in early laryngeal cancer management.
Objectives: To compare long-term functional morbidity and survival outcomes between transoral robotic surgery (TORS) and primary radiation therapy (RT) for early-stage laryngeal squamous cell carcinoma (LSCC).
Study Design: Retrospective cohort study.
Methods: Using the TriNetX US Collaborative Network (2005-2025) a national electronic medical record database–adults with stage I-II LSCC were identified and grouped by primary treatment: TORS (n=276) or RT (n=827). Patients receiving chemotherapy were excluded. Cohorts were propensity score matched 1:1 (n=234 per group) for demographics, comorbidities, substance use, and T-stage distributions (TORS T1: [63.3%; T2: 21.0%]; RT [T1: 62.4%; T2: 20.1%]). Outcomes within 6 months, 1 year, 3 years, 5 years, and any time after treatment were included and compared dysphagia, dysphonia, tracheostomy and gastrostomy dependence, malnutrition, speech rehabilitation utilization, swallow evaluation, depression, anxiety, and overall survival.
Results: TORS procedures included microlaryngoscopy with excisions or biopsy (74%); alongside partial or hemilaryngectomy and subtotal or supraglottic laryngectomy (22%). At 5 years, TORS was associated with higher odds of dysphonia (OR 2.65 [95% CI 1.39-5.06]) and greater speech rehabilitation utilization (OR 2.92 [95% CI 1.52-5.59]). TORS demonstrated non-significant but lower odds of dysphagia (OR 0.72 [95% CI 0.43-1.21]) and comparable rates of tracheostomy dependence (OR 0.90 [95% CI 0.44-1.84]) and swallow evaluation (OR 1.82 [95% CI 0.81-4.07]. Malnutrition trended lower among TORS patients (OR 0.67 [95% CI 0.29-1.53]), while depression (OR 0.59 [95% CI 0.27-1.31]), and anxiety (OR 1.88 [95% CI 0.90-3.93]) were not significantly different between groups. Five-year and anytime survival was equivalent between TORS and radiation (5 year: HR 0.73 [95% CI 0.47-1.12]; Anytime: HR 0.80 [95% CI 0.55-1.16]).
Conclusions: For early-stage LSCC, TORS and radiation achieve comparable survival but distinct functional outcomes. These results highlight the importance of individualized treatment plans in early laryngeal cancer management.