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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Presentation 7 - Head and Neck Surgery

Does Smoking Influence Outcomes in Human Papillomavirus–Associated Oropharyngeal Cancer Treated with Transoral Robotic Surgery?

Monday, October 13, 2025
4:12 PM - 4:18 PM EDT
Location: 127
Disclosure(s):
Jane Y. Tong, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Kyle M. Hatten, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Smoking has been implicated as a risk factor for recurrence in HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) treated with definitive chemoradiation. Whether the same prognostic significance applies to patients undergoing surgical treatment such as transoral robotic surgery (TORS) is less well studied.

Methods: Patients with HPV-associated OPSCC treated with TORS from January 2016 to December 2023 were retrospectively reviewed. Demographics, smoking history, disease characteristics, treatment, and oncologic outcomes were collected. Smoking history was categorized as never, former, or current, with less than one-pack-year considered never smokers.

Results: 156 patients were included. 87.2% were male with median age 60.0 years. Seventy-seven were never smokers, 63 former smokers, and 16 current smokers, with a median 20 pack-years among ever smokers. Three local, six regional, and ten distant metastases were identified, with six total deaths, over a median 2.2 years of follow up. When comparing never, former, and current smokers, primary tumor site differed significantly (p=0.002), however the palatine tonsil was universally most common. Never smokers demonstrated less advanced pathologic nodal staging (p=0.031) and less extranodal extension (p=0.050). When comparing never and ever smokers, never smokers were significantly younger (p=0.036), but primary site no longer differed significantly (p=0.051). Ever smokers had more advanced nodal stage (p=0.012) and more extranodal extension (p=0.017). There were no significant differences in adjuvant treatment, disease recurrence, or death, in either analysis. There were no significant differences apart from age when analyzed using a 10-pack-year or 20-pack-year smoking history cutoff (p=0.006, p=0.015).

Conclusions: Smoking history does not appear to influence recurrence or death in the setting of HPV-associated OPSCC definitively treated with TORS. Smoking may be associated with more advanced nodal disease and extranodal extension.

    Presenting Author(s)

  • Jane Y. Tong, MD

    Resident Physician
    University of Maryland Medical Center
    Baltimore, MD, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Vera A. Bzhilyanskaya, Other

    Medical Student
    University of Maryland Medical Center
    Baltimore, MD, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Kyle M. Hatten, MD

    Associate Professor
    University of Maryland Medical Center
    Baltimore, MD, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.