Complications following salvage transoral robotic surgery with and without reconstruction: A systematic review of the literature

•The pooled overall complication rate for salvage TORS in the literature is 33.6% (95% CI – 25.4%-42.3%).•The pooled upfront tracheostomy rate and the pooled emergency tracheostomy rate in the literature were 22.8% (95% CI 9.1–39.7%) and 4.4% (95% CI − 1.5%-8.3%).•The pooled overall and major hemorr...

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Bibliographic Details
Published in:Oral oncology 2023-10, Vol.145, p.106467-106467, Article 106467
Main Authors: Turner, Meghan T., Chung, Jeffson, Noorkbash, Seth, Topf, Michael C., Hardman, John, Holsinger, F. Christopher, Paleri, Vinidh
Format: Article
Language:English
Subjects:
Reconstruction
Recurrent head and neck cancer
salvage TORS
Salvage transoral robotic surgery
Second primary cancer
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Summary:•The pooled overall complication rate for salvage TORS in the literature is 33.6% (95% CI – 25.4%-42.3%).•The pooled upfront tracheostomy rate and the pooled emergency tracheostomy rate in the literature were 22.8% (95% CI 9.1–39.7%) and 4.4% (95% CI − 1.5%-8.3%).•The pooled overall and major hemorrhage rates after salvage TORS in this review were 12.0% (95% - CI 8.6–15.8%) and 10.5% (95% - CI 6.5%-15.1%).•The pooled perioperative mortality rate attributable to salvage TORS in the literature is 3.6% (95% CI: 0.6% − 8.1%).•The overall rate of reconstruction following salvage TORS in the literature is 9.19%; reconstruction reduced overall hemorrhage rates, but not major hemorrhage rates. Transoral robotic surgery (TORS) has been used in the salvage setting for head and neck cancers both with and without reconstruction. The complications of salvage TORS and the effect of reconstruction on complications has not been studied. To study the complications of salvage TORS and examine the effect of reconstruction on complication rates.Method:An electronic search of the English- language literature using PubMed, Medline, and the Cochrane database was conducted and a systematic review performed in accordance with PRISMA guidelines (CRD42020181057). A total of 23 studies including 533 patients have been published on salvage TORS.The average patient age was 61.2 years.Prior treatment was described for 420 patients.205 (48.8%) underwent prior definitive radiotherapy (RT).160 (38.1%) underwent definitive chemoradiotherapy (CRT).Only 55 (13.1%) had prior surgery.Overall, there were 158 complications with a pooled rate of 33.6% (95%CI: 25.4–42.3%).77 were major complications requiring surgical intervention with a pooled rate of 18.9% (95% CI: 14.8–23.3%).The number of patients undergoing reconstruction among salvage cases in the literature is 59 (9.19%), with 24 local flaps and 25 microvascular free flaps.Reconstruction was associated with lower overall hemorrhage rates but had no impact on major hemorrhage rates. The pooled incidence rates of major complications, major POH and emergency tracheostomy following salvage TORS are 18.9%, 10.5%, and 4.4%.The rate of death following salvage TORS is 3.6%. Reconstruction was associated with lower overall hemorrhage rate after salvage TORS but had no impact on major postoperative hemorrhage rates.
ISSN:1368-8375
1879-0593
DOI:10.1016/j.oraloncology.2023.106467