Trans-oral robotic surgery in the management of malignant oropharyngeal minor salivary gland tumors: A systematic review

Objective: The aim of this study is to evaluate trans-oral robotic surgery (TORS) in the treatment of oropharyngeal minor salivary glands (OPMSG) malignancies. Methods: This study was performed according to the PRISMA statement. A systematic review was performed following a comprehensive electronic search in PubMed, Google Scholar and ScienceDirect databases for studies published until April 21st, 2024. Results: Eleven studies were included in our analysis. A total of 180 patients (males: 44.8 %, n = 78/174) with a median age of 59.6 years (n = 174; IQR 53-72) who underwent OPMSG malignant tumor TORS resection were included. The most common histology was mucoepidermoid carcinoma (n = 76/161, 47.2 %), followed by adenoid cystic carcinoma (n = 42/161, 26.1 %) and polymorphous low-grade adenocarcinoma (n = 17/161, 10.6 %). 87.9 % of OPMSG were classified as T1-T2 (n = 153/174). The median hospitalization time was 4 days (n = 154; IQR 2-6.5). The median initiation of oral diet following surgery occurred on post-operative day 1 (n = 15; IQR 1-4). Post-operative complications, occurring within 30 days from the TORS procedure, presented in 5.8 % of cases (n = 10/172). Negative margins after resection of primary tumor were obtained in 80.4 % of cases (n = 139/173). Conclusions: This systematic review confirms the safety and feasibility of TORS in the treatment of OPMSG malignancies. However, due to the low quality of included studies, further evidence is needed to establish clinical guidelines.