Anfal B Basheer, Ghada A Al-Abdullah, Eman A Alzaher, Rahaf H Alharbi, Mohammed S Aljabri, Ghadah Khalid H Alanazi, Mohammed A Alharbi, Ghaida Y Alsahli, Yousef H AlYousef, Maha Al-Gilani
Oropharyngeal squamous cell carcinoma (OPSCC) represents a growing global health concern, particularly with the rising incidence of human papillomavirus-associated disease. Transoral robotic surgery (TORS) has emerged as a minimally invasive alternative to conventional open approaches, offering enhanced visualization and potentially reduced morbidity compared with mandibulotomy and transcervical techniques. This systematic review and meta-analysis aimed to compare functional, oncological, and postoperative outcomes between TORS and open surgery in patients with OPSCC. The review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD42024616159). A comprehensive search of PubMed, Cochrane Library, Google Scholar, and ClinicalTrials.gov from database inception to November 2024 identified eligible comparative studies. Data extraction and risk-of-bias assessment were performed independently by two reviewers, and meta-analysis was conducted using RevMan 5.3. Seven studies comprising 15,907 patients were included, of whom 2,164 underwent TORS and 13,742 underwent open surgery. TORS was associated with improved functional outcomes, including lower tracheostomy rates, shorter hospital stay, and reduced feeding tube dependence. Recurrence rates and overall survival favored TORS, while postoperative complications and positive margin rates were comparable between groups. Despite moderate heterogeneity and the absence of randomized trials, these findings suggest that TORS provides meaningful functional and oncological advantages. Further high-quality randomized studies are warranted to confirm long-term outcomes and optimize patient selection.