목적: Therapeutic options for human papillomavirus (HPV) - related oropharyngeal cancer include both surgery and CCRTx. As the operation trend in OPSCC after FDA approval of transoral robotic surgery(TORS) has shown great increase of robotic surgery, our institute have previously applied and proved the feasibility of robot-assisted neck dissection combined with TORS. Since HPV-related OPSCC has a favorable prognosis, multiple clinical trials for adjuvant therapy de-escalation in p16-positive OPSCC are currently being considered with the goal of decreasing treatment- associated morbidity without compromising tumor control. This study aims to analyze the natural course of HPV positive & node positive OPSCC that have underwent robot-assisted neck dissection without any adjuvant therapy. 방법:Among 258 cases of TORS & RAND on oropharyngeal cancer between April 2011 and July 2021, we selected 26 patients that have matched the NCCN guideline indications for adjuvant therapy, but however managed to remain surgery alone. 결과:Among the 26 patients, 12 patients were recommended for adjuvant, but refused by the patient, the other 14 patients had traditional risk factors, however determined surgery alone by the surgeon. After case matching with the adjuvant therapy treated group and conventionally treated groups, and controlling for age, pathological stage, the receipt of adjuvant therapy was not significantly associated with DFS (adjusted hazard ratio, 0.90). 결론:The role of adjuvant chemotherapy in HPV-related OPSCC is becoming unclear regarding both conventionally managed neck and also robot- assisted neck treated patients. Depending on our results, adjuvant treatment can be chosen for highly-selected patients in HPV related OPSCC based on other risk factors. Furthermore, new guidelines for adjuvant therapy for HPV-related OPSCC is needed to allow prevention of potential radiation-induced late complications while keeping RT as an option for any second primary lesions whenever needed.