Transoral Robotic Surgery (TORS) for Head and Neck Cancer in the Elderly Population: Functional Outcomes, Survival, and Complications

Abstract

Objective: To compare functional and oncologic outcomes in elderly (>= 70 years) and nonelderly (< 70 years) patients after transoral robotic surgery (TORS). Methods: A retrospective chart review was conducted on 114 patients who underwent TORS for head and neck squamous cell carcinoma between 2012 and 2022. Patient and tumor characteristics, perioperative details, complications, and survival parameters were analyzed. Swallowing function was assessed using the Functional Outcome Swallowing Scale (FOSS). Results: Of the 114 patients, 37 (32.5%) were elderly, and 77 (67.5%) were nonelderly. Elderly patients had higher comorbidity scores (p < 0.001). Oropharyngeal and oral cavity primaries were more common in the nonelderly group, whereas laryngeal primaries predominated in elderly patients (p < 0.01). Complication rates were higher in nonelderly (37.6%) than in elderly (18.9%) patients, though not statistically significant (p = 0.07). In elderly patients, FOSS scores showed no significant change preoperatively, postoperatively (< 3 months), or at the last follow-up (median 36 months). The nonelderly group experienced worse early postoperative FOSS scores compared to baseline but showed significant improvement, returning to preoperative levels by the last follow-up. Nonelderly patients had better FOSS scores at last follow-up compared to elderly patients (p = 0.014). Overall and recurrence-free survival outcomes were better in the nonelderly group, but disease-specific survival rates were comparable. Conclusion: Despite higher comorbidity rates in the elderly, TORS demonstrated favorable complication rates in the elderly population. Swallowing function returned to baseline after 3 months in both groups. TORS appears safe for elderly patients with comparable oncologic outcomes.