Is the current oropharyngeal cancer T classification adequate in the era of HPV and transoral robotic surgery?

Trans-oral robotic surgery (TORS) was approved by the United States Food and Drug Administration for the treatment of oropharyngeal squamous cell carcinoma (OPSCC) in 2009. The number of patients treated with up-front TORS has dramatically increased, particularly after the discovery of the HPV status as a prognostic factor in OPSCC. The 8th edition of the American Joint Committee on Cancer (AJCC) staging manual and the National Comprehensive Cancer Network (NCCN) distinguish HPV positive and HPV negative tumors as two distinct entities with dedicated TNM staging and clinical practice guidelines.