Five-year outcomes of transoral robotic surgery with or without neoadjuvant chemotherapy in laryngeal squamous cell carcinoma: a preliminary experience

Objective: Organ preservation is a key goal in management of laryngeal cancer. The combination of neadjuvant chemotherapy (NACT) and transoral robotic surgery (TORS) may extend minimally invasive surgery indications, but long-term data remain limited. This study evaluated 5-year oncologic outcomes of TORS with or without NACT in laryngeal squamous cell carcinoma (LSCC). Methods: We retrospectively analysed 37 LSCC patients treated between 2012 and 2017 with TORS, with NACT administered in advanced-stage disease. Kaplan-Meier analysis was used to estimate overall (OS), disease-specific (DSS), and disease-free survival (DFS). Survival differences were assessed using the log-rank test. Results: Mean follow-up was 73 months. In patients treated by TORS alone, we observed one-, 3-, and 5-year OS and DSS of 100%, with one-year DFS of 88.9% decreasing to 77.8% at 3- and 5-year, and 100% of laryngeal preservation rate. In patients with locally advanced cT3-4N+ cancer who underwent NACT followed by TORS, 5-year OS, DSS, and DFS were 82.4%, 93.3%, and 61.1%, respectively, with a 84.4% 5-year laryngeal preservation rate. Conclusions: TORS provides excellent long-term oncologic control in early LSCC. The addition of NACT allows extension to advanced disease while maintaining high laryngeal preservation rates, supporting a multimodal organ-preserving strategy.