Background The value of transcervical arterial ligation during transoral robotic surgery (TORS) as a measure to decrease postoperative bleeding incidence or severity is unclear. Methods A retrospective single institution study was performed to identify risk factors for hemorrhage after TORS for oropharyngeal squamous cell carcinoma (SCC). Results Overall, 13.2% of patients (35/265) experience postoperative hemorrhage. T classification, perioperative use of anticoagulants, surgeon experience >50 cases, and tumor subsite were not predictors of postoperative hemorrhage. Of this cohort, 28% underwent prophylactic arterial ligation. The overall incidence of bleeding was not significantly decreased in patients who underwent arterial ligation (12.1% vs 13.6%; p = .84). However, arterial ligation significantly reduced the incidence of major and severe bleeding events (1.3% vs 7.8%; p = .04). Radiation before TORS was a risk factor for major and severe postoperative hemorrhage (p < .02). Conclusion Transcervical arterial ligation during TORS may reduce the severity of postoperative hemorrhagic events.

This systematic review with meta-analysis suggests that ECD has a similar recurrence rate as SP with fewer postoperative complications. ECD may be considered an alternative surgical modality for select benign parotid neoplasms.

HCCC has an overall good prognosis with potential for aggressive behavior. The presence of necrosis, locoregional disease, or positive margins is associated with risk for recurrence.

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Introduction: The COVID-19 pandemic has raised controversies regarding safe and effective care of head and neck cancer patients. It is unknown how much the pandemic has changed surgeon practice.Methods: A questionnaire was distributed to head and neck surgeons assessing opinions related to treatment and concerns for the safety of patients, self, family, and staff.Results: A total of 67 head and neck surgeons responded during the study period. Surgeons continued to recommend primary surgical treatment for oral cavity cancers. Respondents were more likely to consider non-surgical therapy for patients with early glottic cancers and HPVmediated oropharynx cancer. Surgeons were least likely to be concerned for their own health and safety and had the greatest concern for their resident trainees.Conclusions: This study highlights differences in the willingness of head and neck surgeons to delay surgery or alter plans during times when hospital resources are scarce and risk is high.

The impact of the coronavirus disease 2019 pandemic on the management of head and neck cancer must be addressed. Immediate measures to reduce transmission rates and protect patients and providers take priority and necessitate some delays in care, particularly for patients with mild symptoms or less aggressive cancers. However, strict guidelines have yet to be developed, and many unintentional delays in care are to be expected based on the magnitude of the looming public health crisis. The medical complexity of head and neck cancer management may lead to prolonged delays that worsen treatment outcomes. Therefore, those caring for patients with head and neck cancer must take action to reduce these negative impacts as the country rallies to overcome the challenges posed by this pandemic.

BACKGROUND Transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) has been associated with improved long-term dysphagia symptomatology as compared to chemoradiation. Dysphagia in the perioperative period has been inadequately characterized. The objective of this study is to characterize short-term swallowing outcomes after TORS for OPSCC. METHODS Patients undergoing TORS for OPSCC were prospectively enrolled. The Eating Assessment Tool 10 (EAT-10) was used as a measure of swallowing dysfunction (score > 2) and was administered on post-operative day (POD) 1, POD7, and POD30. Patient demographics, weight, pain level and clinical outcomes were recorded prospectively focused on time to oral diet, feeding tube placement and dysphagia-related readmissions. RESULTS 51 patients were included with pathologic T-stages of T1 (24), T2 (20), T3 (3), Tx (4). Self-reported preoperative dysphagia was unusual (13.7%). The mean EAT-10 score on POD1 was lower than on POD7 (21.5 vs. 26.6, p=0.005) but decreased by POD30 (26.1 to 12.2, p<0.001). 47/51 (92.1%) were discharged on an oral diet but 57.4% required compensatory strategies or modification of liquid consistency. 98.0% of patients were taking an oral diet by POD30. There were no dysphagia-related readmissions. CONCLUSIONS This prospective study shows that most patients who undergo TORS experience dysphagia for at least the first month post-operatively but nearly all can be started on an oral diet. The dysphagia-associated complication profile is acceptable after TORS with a minority of patients requiring temporary feeding tube placement. Aggressive evaluation and management of postoperative dysphagia in TORS patients may help prevent dysphagia-associated readmissions.

CT is not a reliable method for determining the presence of ECS in p16-positive HNSCC patients.