Transoral robotic approaches for benign and malignant parapharyngeal space tumors: comparative analysis and systematic review

Objective The objective of this systematic review was to provide a comprehensive overview of the clinical characteristics of patients with parapharyngeal space (PPS) tumors treated with transoral robotic surgery (TORS). Additionally, comparative analyses were conducted to evaluate differences based on tumor histology, tumor location, and the type of transoral robotic approach used. Methods A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines. A comprehensive electronic search was performed across Embase, PubMed, Scopus, and Cochrane Library to identify studies published between 2007 and 2024. Results A total of 31 studies met the inclusion criteria, encompassing individual data from 148 patients. The TORS-combined approach was more frequently employed in the management of malignant PPS (p = .010), with a larger size (p = <.001). Furthermore, malignant PPS tumors presented a higher incidence of feeding tube placement, tracheotomy, and prolonged hospitalization when compared to benign neoplasms (p < .001). Post-operative complications were related to retro-styloid tumors (p = .023). Conclusions The TORS-only approach is appropriate for the treatment of isolated, small, and well-encapsulated tumors. Based on previously published evidence, a TORS-combined approach has been recommended for the management of malignant tumors exceeding 3 cm in diameter. In the current analysis, larger tumor size was associated with the choice of a TORS-combined procedure, but this was not directly correlated with malignant histology