Reconstruction of Oropharyngeal Defects After Transoral Robotic Surgery. Review and Recommendations of the Commission of Head and Neck Surgery of the Spanish Society of Otolaryngology and Head and Neck Surgery

García, José Ángel González; Guisasola, Carlos Pollán; Estomba, Carlos Miguel Chiesa; Soria, Constanza Viña; Porcuna, David Virós

doi:10.1016/j.otoeng.2019.03.004

Cited by 5 publications

(9 citation statements)

References 75 publications

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“…Decisions on whether to perform reconstructive surgery were based on resection depth and prior treatments, as previously reported 7 (Figure 2). All patients undergoing TORS were candidates for free flap reconstruction.…”

Section: Study Design and Patient Inclusionmentioning

confidence: 99%

“…F I G U R E 2 Criteria for performing reconstructive surgery after TORS. 7 The decision to use free flap reconstruction is based on surgical defect and previous treatment received. The choice of flap depended on the patient's characteristics and the need for thick soft tissue or a flat flap.…”

Section: Central Oropharyngectomy With Total Glossectomymentioning

confidence: 99%

“… 2 , 3 In recent years, technological improvements and increased surgical experience with TORS have led several teams to expand the size and complexity of resections performed with this method. 4 , 5 In contrast, a small number of teams have proposed the reconstruction of pharyngeal defects with other methods, including a local or distant free flap, 6 , 7 because secondary intention healing often obviates the need for reconstruction after TORS. In general, however, TORS is being increasingly used for the resection of more advanced oropharyngeal cancers, even those requiring free flap reconstruction, 8 , 9 , 10 , 11 , 12 especially in cases that traditionally would have been approached with lip‐splitting mandibulotomy or pull‐through surgery.…”

Section: Introductionmentioning

confidence: 99%

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Oropharyngeal free flap reconstruction: Transoral robotic surgery versus open approach

Virós Porcuna,

Viña Soria,

Vila Poyatos

et al. 2023

Laryngoscope Investig Oto

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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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Section: Study Design and Patient Inclusionmentioning

confidence: 99%

Section: Central Oropharyngectomy With Total Glossectomymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oropharyngeal free flap reconstruction: Transoral robotic surgery versus open approach

Virós Porcuna,

Viña Soria,

Vila Poyatos

et al. 2023

Laryngoscope Investig Oto

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“…Class I and II defects are amenable to secondary healing, primary closure, or local flaps, while class III and IV defects are typically reconstructed with more advanced regional flap techniques and free tissue transfer. González García and the Spanish Commission of Head and Neck Surgery incorporate the presence of prior treatment into their algorithm and recommend reconstruction with vascularized tissue in this setting [27 ▪ ]. More recently, Avilés-Jurado et al [29] proposed the Hospital Clínic of Barcelona Transoral Resection and Reconstruction (HC-TORR) classification and considers the scenario of salvage surgery following RT failure, depth of resection, and superficial extension of the tumor.…”

Section: Recent Findingsmentioning

confidence: 99%

“…Several reconstructive algorithms have been suggested [18,20,27 ▪ ,28,29]. Although no consensus classification exists, the algorithm proposed by Almeida et al [30,31] is perhaps the most widely utilized within the TORS context.…”

Section: Recent Findingsmentioning

confidence: 99%

Oropharyngeal reconstruction after transoral robotic surgery

Silverman

Birkeland

Bewley

2022

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewTransoral robotic surgery (TORS) has experienced an evolution in recent years. This technique has proved to be a safe and effective method for extirpation of select oropharyngeal tumors. Advances in technology as well as improved surgeon experience allow for the resection of larger, more complex cancers. Although healing by secondary intention remains the current standard for limited oropharyngeal defects, larger resections demand reconstruction with vascularized tissue to minimize morbidity and optimize functional outcomes. The objective of this review is to evaluate recent literature regarding oropharyngeal reconstruction after TORS. Recent findingsA variety of reconstructive options to manage oropharyngeal defects exist. Several reconstructive algorithms have been suggested; however, careful consideration must be used to select the most ideal flap type. Locoregional flaps have shown excellent functional outcomes with limited morbidity. An increase in free flap reconstruction has been demonstrated, particularly among patients with larger TORS defects and following chemoradiation therapy. Despite limited data, robotic-assisted flap inset and microvascular anastomosis has recently shown promise. SummaryReconstruction and flap selection following TORS should be tailored to the patient and unique oropharyngeal defect. Functional outcomes are promising with low complication rates among these patients. Keywordsfree flap, locoregional flap, oropharyngeal reconstruction, transoral robotic surgery & ,5]. Importantly, TORS may obviate the need for open surgical approaches and adjuvant therapy, thereby reducing functional morbidity and toxicities [6,7 && ,8].Despite the advantages of robotic-assisted surgery, oropharyngeal resection with TORS may still result in sizeable defects which necessitate reconstruction. As indications for TORS expand to include larger and more complex resections, careful consideration is required to select the most appropriate

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Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

et al. 2022

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We performed a systematic review to characterize reconstructive modalities and postoperative surgical outcomes following TORS resection. A search of the PubMed, SCOPUS, and EMBASE databases was conducted to identify studies describing patients undergoing reconstruction of TORS defects. Twenty‐six studies met inclusion criteria, consisting of 260 patients who underwent TORS resection followed by reconstruction. Twenty‐one studies reported tumor classification information, with TORS performed for 44 (23.0%) T1, 86 (45.0%) T2, 33 (17.3%) T3, and 28 (14.7%) T4 tumors. Eighteen distinct reconstructive modalities were described in the studies identified, including nine unique free flap types. The most commonly performed reconstruction was the radial forearm free flap (RFFF), accounting for 121/260 (46.5%) of reconstructions performed. Reported surgical complications included 5 pharyngocutaneous fistulae, 13 hemorrhagic complications, 24 infectious complications, and 5 free flap failures. Our findings demonstrate favorable surgical outcomes but minimal quantitative functional data to compare reconstructive options following TORS.

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Reconstruction of Oropharyngeal Defects After Transoral Robotic Surgery. Review and Recommendations of the Commission of Head and Neck Surgery of the Spanish Society of Otolaryngology and Head and Neck Surgery

Cited by 5 publications

References 75 publications

Oropharyngeal free flap reconstruction: Transoral robotic surgery versus open approach

Oropharyngeal free flap reconstruction: Transoral robotic surgery versus open approach

Oropharyngeal reconstruction after transoral robotic surgery

Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

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