Comparing Technical Feasibility of Non-robotic Retroauricular Versus Transcervical Approach Neck Dissection in Oral Canc
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ORIGINAL ARTICLE
Comparing Technical Feasibility of Non-robotic Retroauricular Versus Transcervical Approach Neck Dissection in Oral Cancers—a Preliminary Single Institute Experience Siddharth Shah 1
&
Aditi Bhatt 1 & Raghuvir Solanki 1 & Nirav Thakkar 1 & Sakina Shaikh 1 & Mahesh H Patel 1
Received: 25 March 2019 / Accepted: 15 October 2020 # Indian Association of Surgical Oncology 2020
Abstract Recent advances in minimal access/invasive surgeries in head and neck (robotic/endoscopic assisted) allow neck dissection without a visible scar through a retroauricular approach unlike conventional approach giving visible scar and its sequelae. We retrospectively reviewed prospectively collected data of 80 neck dissections in 72 patients from April 2017 to June 2018 for all newly diagnosed squamous cell carcinoma of oral cavity. We compared between the operative and postoperative outcomes in open- and endoscopic-assisted retroauricular approach (RA) in these patients undergoing neck dissections. Thirty-two out of seventy-two patients underwent retroauricular (RA) approach neck dissection while 40/72 patients underwent conventional open approach neck dissection. RA group had more early staged oral cancers 20/32 (62.5%) as compared to 9/40 (22.5%) in the open approach (p = 0.025). Average nodal yield and nodal yield according to levels were not statistically different in both groups. Nodal failure in both groups was also not statistically significant (p = 0.82). Postoperative complications like marginal weakness, hematoma, microvascular-related problems, and wound problems were not significantly related to the type of approach. We recommend in select group of early oral cancers the retroauricular-assisted neck dissection as minimally invasive, cost-effective, and oncologically safe approach for a scar-free neck surgery. Keywords Retroauricular neck dissection . Non-robotic neck dissection . Scarless neck dissection . Minimal invasive neck dissection
Introduction A benign neck mass, thyroid/parathyroid lesion, or a neck dissection for head and neck cancer requires approaching these lesions directly via transverse cervical neck incision. However, these incisions leave behind visible neck scar [1]. Especially wound dehiscence and poor healing resulting into contractures and scar hypertrophy make this scar more prominent. The advancements in minimally invasive techniques have allowed improved cosmetic outcomes with reduced morbidity related to head and neck surgery [2, 3]. A retroauricular (RA) access to the neck allows management
* Siddharth Shah [email protected] 1
Department of Surgical Oncology, Zydus Hospital, Ahmedabad, Gujarat, India
of these benign lesions by hiding the scar behind the auricle in the posterior hairline. Surgeries for parotid gland tumors, submandibular gland tumors, branchial cleft cysts, and lymph nodes or soft tissue at levels II/III regions via retroauricular (RA) approach can be performed using endoscope or robotic system [4–7]. Endoscopic-assisted selective neck dissection via a RA or
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