Reconstrucción de defectos orofaríngeos tras cirugía transoral robótica. Revisión y recomendaciones de la Comisión de Cirugía de Cabeza y Cuello de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello

ObjectiveTransoral robotic surgery (TORS) has evolved since its 2009 US Food and Drug Administration approval for use in local stage T1–T2 oropharyngeal carcinoma. The ability to resect increasingly larger and more complex lesions has led to the need to introduce reconstructive techniques through this route, avoiding the classic transmandibular or pull‐through approach. Few studies have compared the safety, efficacy, and advantages of TORS versus classic open approaches in oropharyngeal salvage surgery with reconstruction using microanastomosed flaps. Here we retrospectively compare our center's experience with the open approach and TORS and describe the technical variations used.MethodsBetween 2013 and 2021, 30 stage III–IV oropharyngeal cancer patients underwent salvage surgery with reconstruction in our center. From 2013 to 2017, 15 patients underwent surgery with the classic open approach, and from 2018 to 2021, an additional 15 patients underwent TORS. We have compared surgical outcomes, post‐surgical results, and survival in the two groups.ResultsPatient characteristics were similar in the two groups. TORS was associated with shorter surgical time (p < .001), fewer complications (p = .01), shorter hospital stay (p < .001), and lower feeding tube requirements (p = .003). No significant differences were observed between the two groups in the free margin rate or survival.ConclusionOropharyngeal salvage surgery with TORS with free flap reconstruction reduced associated morbidity compared to the open approach in a patient cohort with poor prognosis.Level of Evidence4.

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Oropharyngeal reconstruction with buccinator myomucosal island flaps: Functional outcomes and quality of life. A retrospective observational study

Carnevale,

Sarría‐Echegaray,

Morales Olavarría

et al. 2024

Laryngoscope Investig Oto

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BackgroundThe buccinator myomucosal island flaps are an excellent option for “like with like” oropharyngeal reconstruction in selected cases. We report a series of 15 patients and discuss the functional outcomes.MethodsFrom January 1, 2020 to February 31, 2023, 15 patients underwent oropharyngeal tumor resection and reconstruction with myomucosal island flaps. Buccal artery myomucosal island flap and tunnelized facial artery myomucosal island flap were used in 10 and 5 patients, respectively. In four cases, a total soft palate reconstruction was performed. Before removing the nasogastric tube, a videoendoscopy was performed in all cases to assess postoperative swallowing. Functional assessment was evaluated after a follow‐up of at least 12 months. Speech intelligibility and patient speech perception were assessed using the Hirose's 10‐point scoring system and the Voice Handicap Index. Dysphagia was assessed using the Dysphagia Outcome and Severity Scale and the Dysphagia Handicap Index. Finally, donor site morbidity was analyzed, and quality of life was assessed using the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ‐C30).ResultsThe median length of hospital stay was 10.5 days. Nasal feeding tube was removed on average in 8.6 days after surgery, and all patients were able to tolerate an oral soft diet. Intelligibility was very good in all cases. No major complications were detected, and donor site morbidity was low. Global quality of life was acceptable in all cases.ConclusionsBuccinator myomucosal island flaps represent a very interesting and versatile option for the functional reconstruction of oropharyngeal defects up to 7–8 cm.Level of EvidenceIV

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Reconstrucción de defectos orofaríngeos tras cirugía transoral robótica. Revisión y recomendaciones de la Comisión de Cirugía de Cabeza y Cuello de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello

Cited by 7 publications

References 71 publications

Transoral Robotic Surgery

Transoral Robotic Surgery

Oropharyngeal free flap reconstruction: Transoral robotic surgery versus open approach

Oropharyngeal reconstruction with buccinator myomucosal island flaps: Functional outcomes and quality of life. A retrospective observational study

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