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

Abstract

Background: The incidence of oropharyngeal carcinoma has been on the rise in recent decades. About 30% of patients who undergo definitive chemoradiation as the initial treatment present with residual/recurrent disease. In such a situation, surgical salvage either in the form of traditional open surgery or transoral robotic surgery (TORS) remains a viable treatment option. However, the extensive vascular supply of the posterior tongue and tonsillar bed increases the risk of perioperative bleeding, which is a key concern. The article describes the technique of selective pre-operative embolization to reduce the risk of perioperative bleeding and enumerate its advantages in providing a bloodless field during surgery. Methods: Prospective study of 5 patients with recurrent or residual midline BOT tumours who underwent TORS after selective lingual artery embolization at our centre. Results and Conclusions: None of the patients had any major perioperative bleeding or post procedural complications. All the patients after TORS had their tongue vascularity preserved with adequate recovery of tongue functions. Selective embolization of the feeder vessels provides a favorable bloodless surgical field without affecting the vascular integrity of the remnant tongue. This added advantage helps restoring the normal oral phase of swallowing.

A 3D map of the lingual artery—The perfect tool for transoral robotic surgeries on the base of tongue

“…This shows that prophylactic arterial ligation of the LA may be beneficial for patients that are at an increased risk for severe bleeding events, such as those getting radiation treatment prior to the TORS procedure 2 . A study about selective embolization of the LA in TORS as management of perioperative bleeding was presented by Rao et al 13 The prospective study consisted of five patients with recurrent or residual midline BOT tumors who underwent TORS after selective LA embolization. None of the patients had any major perioperative bleeding or postprocedural complications, and the authors of the said study concluded that selective embolization of the feeder vessels provided a favorable bloodless surgical field without impacting the vascular integrity of the remnant tongue.…”

“…Numerous studies have discussed selective embolization of the LA and transcervical ligation as possible techniques for reducing the risk of both peri-and postoperative hemorrhage during TORS procedures. 2,13 Kubik et al 2 presented a retrospective study that identified risk factors of hemorrhage after TORS for oropharyngeal squamous cell carcinoma. In the study, it was reported that 13.2% of the patients experienced postoperative hemorrhage.…”

Role of transoral robotic surgery in the salvage setting: pitfalls and challenges

“…Complications following TORS surgery have been well-described, including hemorrhage, airway compromise, chronic dysphagia, and spondylitis [49] . Reported rates among patients receiving salvage TORS surgery vary [9,[11][12][13][14][15][16] .…”