{"doi":"10.1002/lary.30784","title":"Transoral Surgery in <scp>HPV‐Positive</scp> Oropharyngeal Carcinoma: Oncologic Outcomes in the Veterans Affairs System","abstract":"OBJECTIVES: Most transoral robotic surgery (TORS) literature for HPV-positive oropharyngeal squamous cell carcinoma (HPV-OPC) derives from high-volume tertiary-care centers. This study aims to describe long-term recurrence and survival outcomes among Veterans Health Administration patients. MATERIALS AND METHODS: Using the US Veterans Affairs database, we identified patients with HPV-OPC treated with TORS between January 2010 and December 2016. Patients were stratified in risk categories: low (0-1 metastatic nodes, negative margins), intermediate (close margins, 2-4 metastatic nodes, lymphovascular or perineural invasion, pT3-pT4 tumor), or high (positive margins, extranodal extension (ENE), and/or ≥5 metastatic nodes). Primary outcomes included overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). RESULTS: The cohort included 161 patients of which 29 (18%) were low-risk, 45 (28%) intermediate-risk, and 87 (54%) high-risk. ENE was present in 41% of node-positive cases and 24% had positive margins. Median follow-up was 5.6 years (95% CI, 3.0-9.3). The 5-year DSS for low, intermediate, and high-risk groups were: 100%, 90.0% (95% CI, 75.4-96.1%), and 88.7% (95% CI, 78.3-94.2%). Pathologic features associated with poor DSS on univariable analysis included pT3-T4 tumors (HR 3.81, 95% CI, 1.31-11; p = 0.01), ≥5 metastatic nodes (HR 3.41, 95% CI, 1.20-11; p = 0.02), and ENE (HR 3.53, 95% CI, 1.06-12; p = 0.04). Higher 5-year cumulative incidences of recurrence were observed in more advanced tumors (pT3-T4, 33% [95% CI, 14-54%] versus pT1-T2, 13% [95% CI, 8-19%]; p = 0.01). CONCLUSIONS: In this nationwide study, patients with HPV-OPC treated with TORS followed by adjuvant therapy at Veterans Affairs Medical Centers demonstrated favorable survival outcomes comparable to those reported in high-volume academic centers and clinical trials. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:207-214, 2024.","journal":"The Laryngoscope","year":2023,"id":355644,"datarank":0.2854850739396865,"base_score":1.791759469228055,"endowment":1.791759469228055,"self_citation_contribution":0.26876392038420827,"citation_network_contribution":0.016721153555478225,"self_endowment_contribution":0.26876392038420827,"citer_contribution":0.016721153555478225,"corpus_percentile":43.513576235785564,"corpus_rank":7303,"citation_count":5,"citer_count":5,"citers_with_citation_signal":1,"citers_with_endowment":1,"datacite_reuse_total":0,"is_dataset":true,"is_dataset_confidence":0.6702,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":263865,"name":"Abhishek Kumar","orcid":"0000-0002-2306-8863","position":1,"is_corresponding":false},{"id":736191,"name":"Rohith S. Voora","orcid":"0000-0001-9242-844X","position":2,"is_corresponding":false},{"id":1104003,"name":"Shady I. Soliman","orcid":"0000-0001-5291-6940","position":3,"is_corresponding":false},{"id":554705,"name":"Daniel Cherry","orcid":"0000-0002-6441-9172","position":4,"is_corresponding":false},{"id":369812,"name":"P.T. Courtney","orcid":"0000-0001-7625-3678","position":5,"is_corresponding":false},{"id":1104004,"name":"Andrey Finegersh","orcid":"0000-0002-2639-2132","position":6,"is_corresponding":false},{"id":282055,"name":"Theresa Guo","orcid":"0000-0002-1689-3275","position":7,"is_corresponding":false},{"id":510055,"name":"Ezra E.W. Cohen","orcid":"0000-0002-9872-6242","position":8,"is_corresponding":false},{"id":24647,"name":"Joseph A. Califano","orcid":"0000-0002-4715-6761","position":9,"is_corresponding":false},{"id":258163,"name":"Loren K. Mell","orcid":"0000-0003-2277-6080","position":10,"is_corresponding":false},{"id":263871,"name":"Brent S. Rose","orcid":"0000-0002-3197-9552","position":11,"is_corresponding":false},{"id":594663,"name":"Ryan K. Orosco","orcid":"0000-0002-7885-4327","position":12,"is_corresponding":false},{"id":108271,"name":"Farhoud Faraji","orcid":"0000-0001-5078-813X","position":0,"is_corresponding":true}],"reference_count":32,"raw_metadata":null,"created_at":"2026-07-19T01:13:21.145955Z","pmid":"37255050","pmcid":"PMC10687307","fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}