Background Residual, recurrent and second primary head and neck cancers (ReRuNe) are on the rise, driven by a younger age at diagnosis and increasingly targeted chemoradiotherapy options. Surgery remains the only curative intent option in this cohort. Transoral robotic surgery is an emerging minimally invasive technique in these patients with limited synthesis level evidence of survival, functional and oncological outcomes. Methods This study represents the largest systematic review till date on this topic from databases including PubMed, Embase and Scopus which found 679 studies and included 15 studies after screening and appraisal. A meta-analysis of proportions and comparison was conducted using Freeman-Tukey arcsine transformation statistical method and the Mantel-Haenszel statistical method respectively. Results Data from 515 patients was analysed with a median follow up time up to 47 months and a mean hospital stay of 8.5 days. 2-year overall survival (OS) rate and disease-free survival (DFS) rate was 73.8% and 56.1% respectively. Compared to primary head and neck cancer (PHNC), risk ratios for OS and DFS were 0.35 (95% CI, 0.18-0.67) and 0.44 (95% CI, 0.22-0.88). Weighted mean for tracheostomy decannulation and nasogastric dependence was 17.7 and 12.8 days respectively, with long term tracheostomy dependence in 0-11.5% of patients. Positive surgical margins were obtained in 19.4% with a risk ratio of 1.08 (95% CI, 0.66-1.75) when compared to PHNC. Recurrence rate was 36% (95% CI, 24-48.9). Pooled complication rate was 32.3% with 92% of complications being classed as Clavien Dindo grade 2 or 3. Conclusion Data from synthesis shows that TORS is a strong emerging technique in ReRuNe HNC with encouraging survival, functional and oncological outcomes. Clinicians should consider incorporating TORS into their surgical repertoire for salvage procedures. Future studies need cohorts with 5-year outcomes to validate these results.