Staged neck dissection prior to transoral robotic surgery for oropharyngeal cancer: does it reduce post-operative complication rates? A multi-centre study of 104 patients

Purpose Transoral robotic surgery (TORS) has become increasingly recognised as a safe and effective treatment for early oropharyngeal squamous cell carcinoma, often performed in conjunction with neck dissection (ND) and vessel ligation. It has been proposed that performing the neck dissection in a s...

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Published in:	European archives of oto-rhino-laryngology 2023-11, Vol.280 (11), p.5067-5072
Main Authors:	Blom, Megan, Zhang, Henry, Tescher, Anne, Dixon, Benjamin, Magarey, Matthew
Format:	Article
Language:	eng
Subjects:	Australia - epidemiology Cutaneous Fistula - etiology Cutaneous Fistula - prevention & control Cutaneous Fistula - surgery Head and Neck Head and Neck Neoplasms - surgery Head and Neck Surgery Humans Medicine Medicine & Public Health Neck Dissection - adverse effects Neck Dissection - methods Neurosurgery Oropharyngeal Neoplasms - pathology Oropharyngeal Neoplasms - surgery Otorhinolaryngology Pharyngeal Diseases - etiology Pharyngeal Diseases - prevention & control Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - prevention & control Postoperative Hemorrhage - epidemiology Postoperative Hemorrhage - etiology Postoperative Hemorrhage - prevention & control Retrospective Studies Robotic Surgical Procedures - adverse effects Robotic Surgical Procedures - methods
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Summary:	Purpose Transoral robotic surgery (TORS) has become increasingly recognised as a safe and effective treatment for early oropharyngeal squamous cell carcinoma, often performed in conjunction with neck dissection (ND) and vessel ligation. It has been proposed that performing the neck dissection in a staged fashion prior to TORS results in low rates of transoral haemorrhage and pharyngocutaneous fistula, and may aid in TORS patient selection by eliminating patients who would require multi-modality treatment based on nodal pathology. This study aims to assess the effect of staged neck dissection with TORS in mitigating pharyngocutaneous fistulae and post-operative haemorrhage as well as the impact of staged ND on TORS patient selection. Methods A retrospective cohort analysis was performed of patients undergoing staged ND with intent to proceed to TORS at two Australian hospitals between 2014 and 2022. Incidence of post-operative haemorrhage and pharyngocutaneous fistula and length of inpatient stay was identified. The number of patients who did not proceed to TORS was recorded. Results One hundred and four patients were identified who underwent staged neck dissection with an intention to proceed to TORS. Six patients did not proceed to TORS following pathological assessment of the neck dissection specimen and ninety-eight patients (91 primary, 7 salvage) underwent TORS. There were six cases of secondary haemorrhage (one major, two intermediate and three minor). There were no cases of pharyngocutaneous fistula. Conclusion Staged neck dissection prior to TORS results in low rates of haemorrhage and pharyngocutaneous fistula and can improve TORS patient selection.
ISSN:	0937-4477 1434-4726