Prophylactic arterial ligation following transoral robotic surgery: A systematic review and meta‐analysis

Abstract

Prophylactic arterial ligation has been proposed to reduce the severity of postoperative hemorrhage following transoral robotic surgery (TORS). Previous studies have shown a trend toward a reduction in major and severe bleeding. Search strategies were implemented in multiple databases and completed in August 2018. Inclusion and exclusion criteria were designed to capture studies examining adults undergoing TORS for oropharyngeal cancer. Four retrospective studies were selected appropriate for analysis by two reviewers who independently extracted data. PRISMA guidelines were followed. A random‐effects model was used for meta‐analysis. Meta‐analysis of 619 patients in four retrospective reviews showed that the pooled RR of major and severe bleeding events was significantly lower in prophylactically ligated patients (RR, 0.28; 95% CI, 0.08‐0.92; I2 = 0). Prophylactic arterial ligation of external carotid artery branches is associated with a decreased risk of major and severe bleeding events, although confounding factors remain incompletely analyzed.

National Analysis of Oropharyngeal Salivary Gland Malignancies Treated With Transoral Robotic Surgery

“…27 Life-threatening bleeding occurs less often, and prophylactic arterial ligation has been recommended to further reduce this risk. 28 This, with greater rates of intermediateand high-grade tumors, may help explain the significantly higher rates of neck dissections performed in the TORS group. Postoperative bleeding, dehydration, and pain have been cited as the most common causes of unplanned readmissions after TORS.…”

Association of comorbidity score with perioperative outcomes following transoral robotic surgery: National analysis

“…In a survey of TORS surgeons in 2013, there were a total of 6 (0.3%) perioperative mortalities out of 2015 cases, all due to postoperative bleeding 19 . More recently, prophylactic arterial ligation has been shown in multiple systematic reviews to be associated with a reduced risk of major and severe bleeding after TORS 20,21 …”

“…19 More recently, prophylactic arterial ligation has been shown in multiple systematic reviews to be associated with a reduced risk of major and severe bleeding after TORS. 20,21 Our study included a number of limitations. As with all studies involving national databases, selection bias, incomplete data, and coding errors limit its use.…”

Selective embolization of lingual artery in transoral robotic surgery for the management of recurrent base of tongue carcinomas

“…Transcervical ligation of feeder vessel to the tumor is a common practice. However, the transcervical ligation of feeder vessels may not always reduce the chances of perioperative bleeding 9‐12 . Furthermore, neck dissection in recurrent oropharyngeal cancers is usually not mandated in the absence of radiological and metabolic evidence of residual neck disease.…”

“…However, the transcervical ligation of feeder vessels may not always reduce the chances of perioperative bleeding. [9][10][11][12] Furthermore, neck dissection in recurrent oropharyngeal cancers is usually not mandated in the absence of radiological and metabolic evidence of residual neck disease. Additionally, neck dissection may increase the risk of pharyngeal communication, wound infection, delayed wound healing, and flap necrosis.…”