Effect of transcervical arterial ligation on the severity of postoperative hemorrhage after transoral robotic surgery

Abstract

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.

First bite syndrome following transcervical arterial ligation after transoral robotic surgery

“…Fatal oropharyngeal hemorrhage is the most feared complication of TORS. To mitigate this, many authors have advocated prophylactic ligation of branches of the ECA during concomitant neck dissection, which may decrease the risk of major and severe bleeding . We present FBS as a rare yet potential complication of the empiric ligation of the portions of the external carotid system.…”

“…Perhaps the most formidable complication after TORS is postoperative hemorrhage, owing to the risk of possible airway compromise and death. Previously published large retrospective studies report postoperative bleeding rates after TORS ranging from 3.1% to 13.2% . Of these, 2% to 5% are major or severe bleeds, defined as brisk or copious bleeding requiring vessel ligation or embolization; or bleeding resulting in life‐threatening medical complications such as airway compromise, hemodynamic instability, and cardiopulmonary arrest .…”

“…In an attempt to limit the risk of this catastrophic outcome, many surgeons have advocated prophylactically ligating selected branches of the external carotid artery (ECA) during concomitant neck dissection. Although the impact of prophylactic transcervical arterial ligation on overall bleeding rates is unclear, studies have shown a trend toward decreased hemorrhage severity in ligated patients . To date, none of the retrospective studies have noted complications, such as neurologic changes, cranial nerve palsies, major vascular injuries, and delayed wound healing attributable to ipsilateral ECA ligation .…”

Readmission after surgery for oropharyngeal cancer: An analysis of rates, causes, and risk factors

“…Bleeding is a potentially life‐threatening complication of oropharyngeal surgery that can lead to airway compromise, asphyxiation, or cardiopulmonary arrest, particularly when severe. An oncologic indication for surgery significantly increases the risk of bleeding, as resection of a known primary cancer may necessitate a deeper plain of resection than required for other surgical indications, thereby placing vascular structures at risk . Strategies to reduce postoperative bleeding are not well‐defined, but have included discontinuation of antithrombotic medications and prophylactic transcervical arterial ligation of branches of the external carotid system .…”

Transoral robotic resection of benign tumors of the upper aerodigestive tract: Experience of the French group of GETTEC

“…For example, the tracheostomy in parapharyngeal benign tumor series is often more frequent if approached transorally, 13,14 and commonly recommended in case of mandibulotomy. 16,17 In addition, the avoidance of a clean-contaminated cervicotomy usually provides quicker wound healing and greatly decreases the rate of postoperative complications, such as surgical-site infections. Some authors even suggest that a prophylactic transcervical arterial ligation during surgery would reduce the incidence or severity of postoperative major bleeding events.…”