The impact of prophylactic external carotid artery ligation on postoperative bleeding after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma

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.…”

“…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

“…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 . Additionally, educating patients and caregivers of potentially subtle symptoms of bleeding such as epistaxis or melena may allow for earlier detection.…”

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

“…Due to the potential for this life‐threatening complication, prophylactic arterial ligation has been proposed to reduce the severity of postoperative hemorrhage . Previous studies have not shown a significant decrease in overall hemorrhage rates, although there has been a trend toward a reduction in major and severe bleeding . This evidence prompted an amendment to the ECOG 3311 trial (NCT01898494), requiring all patients to undergo prophylactic major vessel ligation during TORS .…”