Transoral approaches to the oropharynx: The revival of surgery for oropharyngeal carcinoma

Before the evolution of organ preservation strategies with radiation and chemotherapy, surgery for oropharyngeal carcinoma primarily involved morbid procedures via transcervical and transmandibular routes. Recently, technologic advances have led to renewed interest in upfront surgical treatment for oropharyngeal carcinoma, particularly given the rising incidence of cancers of the oropharynx in contrast to head and neck cancers of other subsites. Specifically, transoral laser microsurgery and transoral robotic surgery are two techniques that allow for complete oncologic resection through the mouth in select patients, with minimal cosmetic deformity and optimal speech and swallow function. This is especially relevant in younger, healthier patients with human papilloma virus associated squamous cell carcinoma. In this article we will review transoral approaches to oropharyngeal carcinoma: its development; oncologic and functional outcomes; and its role in the multi-disciplinary treatment of oropharyngeal cancer.