목적: Recently in tonsil cancer, surgical procedure has become more conservative to decrease the morbidity and functional deficit after surgery. Holsinger et al.introduced transoral lateral oropharyngectomy(TLO)and this method has led to the prevalent use of TORS(Transoral Robotic Surgery) nowdays. We investigated the safety of surgical approach to tonsil cancer and morbidity after surgery in the era of HPV. 방법:A retrospective review of the medical record of the patients who were diagnosed with tonsillar squamous cell carcinoma( SCC) and underwent surgery at our institution from January , 1992 to January, 2013. We reviewed surgical approach, reconstruction after surgery, HPV status, surgical margin, ECS of lymph node and survival rate. HPV detection test was done in 77 paitents by using in situ hybridization technique. 결과:Totally, 108 patients were enrolled to this study and there were 34.7% of patients were revealed positivity in HPV infection. 46 patients had surgery with lateral pharyngotomy and 59 patients had transoral lateral oropharyngectomy including 26 patients with TORS. 5-year DSSR(Disease specific survival rate) was 75.1% overall, 90% in HPV positive group, 61% in HPV negative group. There was no difference in survival rate between TLO and lateral pharngotomy group in HPV positive patients(94.4% vs 85.2%, p-value=0.23). But in HPV negative group, patients who had TLO showed better survival rate than lateral pharyngotomy group, but there was no statistical significancy(69.1% vs 52.6%, p-value=0.15). ECS in lymph node has significant impact to survival rate in overall patients, but there was no stastical difference between ECS positive and negative group in HPV positive patients(79.3% vs 95.5%, p-value=0.10). 결론:When we decide the surgical approach in tonsil cancer, we should have more concerns about HPV status and also more attention should be needed for the functional outcomes.