Transoral robotic approaches to parapharyngeal space malignancies: a systematic review

OBJECTIVE: Transoral robotic surgery (TORS) has emerged as a promising alternative to conventional open approaches for parapharyngeal space malignancies. This review aimed to evaluate the surgical indications, oncologic efficacy and functional outcomes of robotic-assisted procedures. METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. PubMed, Scopus and Cochrane databases were searched for studies published between 2007 and 2025. Eligible studies included patients with parapharyngeal space malignancies managed by transoral robotic surgery or combined transoral robotic surgery-open approaches. RESULTS: Eleven studies, comprising 20 patients, met the inclusion criteria. Ten patients underwent transoral robotic surgery-only resection, with no intra-operative or post-operative complications and no evidence of recurrence during follow-up. Eight patients were treated with combined transoral robotic surgery-open approaches, achieving comparable oncologic control, albeit with a higher rate of tracheostomy and feeding tube placement. CONCLUSION: Transoral robotic surgery-only represents a valid strategy for selected small and well-localised parapharyngeal space malignancies, ensuring favourable oncologic and functional outcomes. Combined transoral robotic surgery-open approaches expand surgical indications to larger and anatomically complex tumours, while maintaining acceptable morbidity and oncologic results.