The Change in Paradigm for Surgical Management of HPV-positive Oropharynx Cancer.

Traditional surgical approaches to all oropharyngeal cancer included open surgery via mandibulotomy or mandibular swing procedures-extensive surgery that often led to tracheostomy, gastrostomy tube dependence, and prolonged hospital stay. As HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) began to increase in prevalence, it became clear that this new disease entity was associated with improved survival. There was therefore a strong desire from surgeons and oncologists to reduce the morbidity associated with its management. The paradigm shift to transoral robotic surgery and transoral laser microsurgery for selected patients with HPV oropharynx cancer has allowed for avoidance of tracheostomy, mandibulotomy, and feeding tube while preserving speech and swallow function. Current research focuses on de-escalating adjuvant treatment in appropriate cases to reduce morbidity without impacting oncologic outcome.