Surgical margins after open versus transoral surgery for oropharyngeal cancer and their impact on the need for multimodal treatments

Objective. In oropharyngeal squamous cell carcinoma (OPSCC), proper definition of surgical margins may have substantial impact on oncologic outcomes. Minimally-invasive techniques prioritise reduced morbidity, yet open approaches remain significant due to limited large-scale evidence comparing their outcomes with transoral methods. The purpose of the present systematic review was to assess the incidence of positive margins in OPSCC management based on surgical approach (open vs transoral) and the subsequent risk of additional treatments. Methods. Medical databases were searched including PubMed, Scopus, EMBASE, and Cochrane Library from January 2000 to August 2024. Data analysis was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and the quality of studies was evaluated using the Newcastle-Ottawa Scale. Results. Four studies, including 305 patients (126 treated by an open approach, and 179 by transoral surgery), were qualitatively analysed. No significant difference was found in the rates of positive margins (p = 0.422) or need for adjuvant therapy (p = 0.368) between the two approaches. It was not feasible to conduct a meta-analysis due to significant inconsistencies in the reporting of data across the studies included. Conclusions. Transoral approach is recommended for early-stage OPSCC when adequate expo sure is achievable, although its impact on positive surgical margins remains unclear. The management of close or positive margins remains debated due to the oropharyngeal unique anatomy and function, with no clear de-intensification protocol established.