Transoral robotic surgery in management of oropharyngeal cancers: a preliminary experience at a tertiary cancer centre in India

Abstract

TORS is a safe, feasible, minimally invasive procedure in patients with oropharyngeal cancers. It has the least morbidity and offers benefits in terms of avoidance of tracheostomy tube, prolonged Ryle's tube and gastrostomy dependency.

Management of the Airway in Transoral Robotic Surgery for Head and Neck Cancer

“…In a third early series of 45 cases, which mostly included tonguebase cancer, 14 patients left the operating theatre with a tracheotomy [17] . In more recent series, the percentage of tracheotomies is lower (4 of 26) [18] or even null [19] , although for the same locations (e.g. supraglottis) there are still large variations that include "always" [20] or "never" [21] .…”

Clinical outcomes of transoral robotic-assisted surgery for the management of head and neck cancer

“…In these case series, resection beds were allowed to granulate and heal by secondary intention. [5][6][7][8][9] Genden et al 10 reported a series of 31 patients with OPSCC who underwent TORS and described the use of a musculomucosal advancement flap pharyngoplasty in 25 of these patients, with radial forearm free flap in the remaining six patients. However, they stated that four of these six patients were salvage candidates.…”

“…The postoperative hospital length of stay (LOS) after TORS with or without neck dissection for OPSCC ranged from 1.0 days to 14.6 days, with all but one study reporting LOS in the range of 1.0-4.3 days. [5][6][7][8][9][11][12][13] Studies comparing LOS following TORS with that following mandibulotomy for similar oropharyngeal lesions consistently report significantly shorter LOS with TORS, whether in the primary or salvage setting. 5,8 Some part of this decreased LOS may be related to decreased need for free flap reconstruction, which typically necessitates intensive postoperative monitoring for longer periods of time, while part of it may be related to decreased time to oral intake, as discussed in subsequent sections.…”

“…Minor postoperative bleeding from the primary resection site was reported in 0%-11% of patients, all within the first week after surgery. [5][6][7][8]10,[12][13][14][15] Two series reported of more serious postoperative bleeds: Dabas et al 7 report on one patient who had bleeding and died, while van Loon et al 6 report on one arterial hemorrhage that required tracheotomy and operative control of hemorrhage. Neck hematomas occurred in a similarly low fraction of patients, with published series reporting 0%-4% of cases with neck hematomas requiring operative drainage.…”

“…Neck hematomas occurred in a similarly low fraction of patients, with published series reporting 0%-4% of cases with neck hematomas requiring operative drainage. [5][6][7][8]10,[12][13][14][15] Pharyngocutaneous fistula has been another common concern after TORS for OPSCC. Moore et al 14 report four cases of pharyngocutaneous fistula out of 66 patients, all of which resolved with packing and required no operative intervention.…”