Despite the widespread adoption of transoral robotic surgery (TORS) in oropharyngeal

cancer, several aspects of surgical strategy remain highly controversial. This round table

will focus on four hot topics that continue to challenge clinical practice: (1) the role of

radiological assessment in surgical planning, with particular attention to whether styloid

process involvement should be considered a contraindication; (2) the debate over margin

adequacy and how oncological safety should be redefined in the HPV-positive era; (3)

the relationship between perioperative bleeding and reconstructive techniques; and (4) the

potential role of neoadjuvant chemotherapy in patient selection and outcomes. Each

controversy will be addressed by expert panelists through short, case-based presentations

followed by open discussion with the audience. The session aims to provide practical

insights, highlight unresolved questions, and foster a multidisciplinary exchange to

optimize surgical decision-making in oropharyngeal TORS.

The management of surgical margins in oral cavity squamous cell carcinoma is a subject of ongoing debate in current literature. While most clinical guidelines define resection margins based on geometric parameters—typically >5 mm in planar measurement or >7 mm³ in three-dimensional assessment—this approach may not account for the complex anatomical and biological variability of the oral cavity. Modern approaches advocate for a more nuanced view that considers the variability in tumor subsites and structural anatomy, as well as key factors such as the tumor infiltration front, the mode of tumor progression (mucosal versus stromal), and the involvement of critical anatomical spaces like the sublingual areas, the T-N tract, and the infratemporal fossa.

There is also ongoing discussion regarding the most effective methods for evaluating surgical margins, including imaging techniques, bioendoscopy, and intraoperative frozen section analysis, with no standardized decision-making algorithm currently established.

Hypopharyngeal carcinoma often presents at an advanced stage and requires aggressive multimodal treatment. Surgery plays a crucial role both as a primary option—combined with chemotherapy and radiotherapy—and increasingly as salvage therapy. Surgical procedures frequently involve neighboring organs such as the larynx and esophagus, making the reconstructive surgeon’s role particularly vital.This round table aims to provide a comprehensive overview of the reconstructive challenges related to hypopharyngeal defects, considering orientation, shape, extent (partial or circumferential), and involvement of adjacent structures.Topics include reconstruction with free and pedicled flaps, salvage settings, and laryngeal preservation. Special focus will be given to complications, pharyngoesophageal rehabilitation, and quality of life.