European surgical guidelines: transoral robotic surgery for head and neck cancers

Background: Substantial heterogeneity in practice exists across centers regarding the indications and perioperative care for patients undergoing transoral robotic surgery (TORS) for head and neck cancer. This consensus paper aims to propose a European surgical practice guideline in this setting. Methods: Twenty-two experts from European and International scientific societies participated in a modified Delphi process for rating and validating statements about indications, contraindications, surgical outcomes, and pre- and postoperative care associated with TORS for head and neck cancer care. Consensus was deemed to have been achieved when two-thirds of experts agreed or strongly agreed with the statement; those with fewer than one-third agreement were improved and resubmitted for voting until final validation or rejection. Results: Of the initial 41 statements, 38 reached consensus after three voting rounds. Statements propose recommendations for the preoperative assessment (n = 7), indications and contraindications for TORS in oropharyngeal, laryngeal, and hypopharyngeal primaries (n = 10), surgical outcomes to be reported (n = 7), postoperative care (n = 8), and clinical research (n = 6). TORS is appropriate for small, accessible oropharyngeal and supraglottic tumors with favorable exposure. The contraindications set out in detail for oropharyngeal, laryngeal and hypopharyngeal lesions will assist in decision-making, especially when presented with a controversial clinical scenario. Standardized reporting of surgical, functional, and oncological outcomes, including swallowing, voice quality, and survival rates, is essential for evidence-based practice. TORS represents a promising avenue for therapeutic de-escalation in HPV-positive oropharyngeal cancers. Conclusion: The European TORS surgical consensus provides clinical recommendations for the indications, contraindications, surgical and perioperative care for TORS management of head and neck malignancies.