Top

European Archives of Oto-Rhino-Laryngology

Published in:

10-08-2023 | Neck Dissection | Head and Neck

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

Authors: Megan Blom, Henry Zhang, Anne Tescher, Benjamin Dixon, Matthew Magarey

Published in: European Archives of Oto-Rhino-Laryngology | Issue 11/2023

Abstract

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.

Weinstein GS, O’Malley BW, Magnuson JS, Carroll WR, Olsen KD, Daio L et al (2012) Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins. Laryngoscope 122(8):1701–1707CrossRefPubMed

Oliver JR, Persky MJ, Wang B, Duvvuri U, Gross ND, Vaezi AE et al (2022) Transoral robotic surgery adoption and safety in treatment of oropharyngeal cancers. Cancer 128(4):685–696CrossRefPubMed

Choby GW, Kim J, Ling DC, Abberbock S, Mandal R, Kim S et al (2015) Transoral robotic surgery alone for oropharyngeal cancer: quality-of-life outcomes. JAMA Otolaryngol Head Neck Surg 141(6):499–504CrossRefPubMed

Lörincz BB, Jowett N, Knecht R (2016) Decision management in transoral robotic surgery: Indications, individual patient selection, and role in the multidisciplinary treatment for head and neck cancer from a European perspective. Head Neck 38(Suppl 1):E2190–E2196PubMed

O’Malley BW, Weinstein GS, Snyder W, Hockstein NG (2006) Transoral robotic surgery (TORS) for base of tongue neoplasms. Laryngoscope 116(8):1465–1472CrossRefPubMed

Möckelmann N, Busch CJ, Münscher A, Knecht R, Lörincz BB (2015) Timing of neck dissection in patients undergoing transoral robotic surgery for head and neck cancer. Eur J Surg Oncol 41(6):773–778CrossRefPubMed

Frenkel CH, Yang J, Zhang M, Altieri MS, Telem DA, Samara GJ (2017) Compared outcomes of concurrent versus staged transoral robotic surgery with neck dissection. Otolaryngol Head Neck Surg 157(5):791–797CrossRefPubMed

Krishnan G, David R, Gouzos M, Foreman A, Krishnan S, Hodge J-C (2018) Evolution of neck dissections performed in conjunction with transoral robotic surgery lateral oropharyngectomy. Aust J Otolaryngol. https://doi.org/10.21037/ajo.2018.01.09

Cooper LN, Crouch S, O’Neill J, Dowthwaite S (2021) Staged neck dissection prior to trans-oral surgery provides a safe and effective treatment paradigm for early oropharyngeal carcinoma. Aust J Otolaryngol. 4:11CrossRef

10.

Crawford JA, Bahgat AY, White HN, Magnuson JS (2016) Hemostatic options for transoral robotic surgery of the pharynx and base of tongue. Otolaryngol Clin North Am 49(3):715–725CrossRefPubMed

11.

Moore EJ, Olsen KD, Martin EJ (2011) Concurrent neck dissection and transoral robotic surgery. Laryngoscope 121(3):541–544CrossRefPubMed

12.

Iseli TA, Kulbersh BD, Iseli CE, Carroll WR, Rosenthal EL, Magnuson JS (2009) Functional outcomes after transoral robotic surgery for head and neck cancer. Otolaryngol Head Neck Surg 141(2):166–171CrossRefPubMed

13.

Stokes W, Ramadan J, Lawson G, Ferris FRL, Holsinger FC, Turner MT (2021) Bleeding complications after transoral robotic surgery: a meta-analysis and systematic review. Laryngoscope 131(1):95–105CrossRefPubMed

14.

Sharbel DD, Abkemeier M, Sullivan J, Zimmerman Z, Albergotti WG, Duvvuri U et al (2021) Transcervical arterial ligation for prevention of postoperative hemorrhage in transoral oropharyngectomy: systematic review and meta-analysis. Head Neck 43(1):334–344CrossRefPubMed

15.

Topf MC, Moritz E, Gleysteen J, Curry JM, Cognetti DM, Luginbuhl AJ (2018) First bite syndrome following transcervical arterial ligation after transoral robotic surgery. Laryngoscope 128(7):1589–1593CrossRefPubMed

16.

Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E et al (2011) Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 29(32):4294–4301CrossRefPubMedPubMedCentral

17.

Cracchiolo JR, Baxi SS, Morris LG, Ganly I, Patel SG, Cohen MA et al (2016) Increase in primary surgical treatment of T1 and T2 oropharyngeal squamous cell carcinoma and rates of adverse pathologic features: National Cancer Data Base. Cancer 122(10):1523–1532CrossRefPubMed

18.

Sethia R, Yumusakhuylu AC, Ozbay I, Diavolitsis V, Brown NV, Zhao S et al (2018) Quality of life outcomes of transoral robotic surgery with or without adjuvant therapy for oropharyngeal cancer. Laryngoscope 128(2):403–411CrossRefPubMed

19.

Nichols AC, Theurer J, Prisman E, Read N, Berthelet E, Tran E et al (2019) Radiotherapy versus transoral robotic surgery and neck dissection for oropharyngeal squamous cell carcinoma (ORATOR): an open-label, phase 2, randomised trial. Lancet Oncol 20(10):1349–1359CrossRefPubMed

20.

Palma DA, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J et al (2022) Assessment of toxic effects and survival in treatment deescalation with radiotherapy vs transoral surgery for HPV-associated oropharyngeal squamous cell carcinoma: the ORATOR2 phase 2 randomized clinical trial. JAMA Oncol 8(6):1–7CrossRefPubMedPubMedCentral

Title: 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
Authors: Megan Blom
Henry Zhang
Anne Tescher
Benjamin Dixon
Matthew Magarey
Publication date: 10-08-2023
Publisher: Springer Berlin Heidelberg
Keyword: Neck Dissection
Published in: European Archives of Oto-Rhino-Laryngology / Issue 11/2023
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-023-08108-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2023

Distinct smell and taste disorder phenotype of post-acute COVID-19 sequelae

The effects of endoscope placement in the hypopharynx on swallowing-related measures in healthy adults

Predictors of aspiration pneumonia: developing a new matrix for speech and language therapists

A deep learning MRI-based signature may provide risk-stratification strategies for nasopharyngeal carcinoma

Matching the pitch perception of the cochlear implanted ear with the contralateral ear in patients with single-sided deafness: a novel approach

The implications of concomitant mucosal inflammation on clinical manifestations and outcomes of sinonasal inverted papilloma