Comparison of Surgical Outcomes of Robotic and Conventional Approaches in Patients with Pre- and Poststyloid Parapharyng
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ORIGINAL ARTICLE – HEAD AND NECK ONCOLOGY
Comparison of Surgical Outcomes of Robotic and Conventional Approaches in Patients with Pre- and Poststyloid Parapharyngeal Space Tumors Jae-Yol Lim, MD, PhD, Young Min Park, MD, PhD, Min Seok Kang, MD, Da Hee Kim, MD, Eun Chang Choi, MD, PhD, Se-Heon Kim, MD, PhD, and Yoon Woo Koh, MD, PhD Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
ABSTRACT Background. Benefits and drawbacks of robotic surgical approaches for parapharyngeal space (PPS) tumors remain undetermined. The purpose of this study is to compare surgical outcomes of PPS tumor patients who underwent robotic surgery with those of patients who received conventional surgical treatment. Patients and Methods. We retrospectively analyzed clinicopathologic data from 136 patients who underwent surgical removal of PPS tumors via conventional or robotic approaches. Results. We identified PPS tumors in pre- and poststyloid regions in 87 (64%) and 49 (36%) patients, respectively. There were 48 (35.3%) pleomorphic adenomas, 36 (26.5%) schwannomas, and 24 (17.6%) paragangliomas. Conventional surgical techniques were performed in 83 patients, and robotic surgical approaches were administered to 53 patients. Transcervical-parotid and transcervical approaches were most commonly performed in conventional surgery, while transoral and retroauricular approaches were the preferred surgical methods in robotic surgery for preand poststyloid PPS tumors, respectively. Robotic surgery resulted in less estimated blood loss during poststyloid PPS tumor surgery. Postoperative cranial nerve complications were noted in 36 of 83 cases (43.4%) in the conventional surgery group and in 17 of 53 cases (32.1%) in the robotic surgery group. Intraoperative tumor spillage of pleomorphic adenoma showed no significant differences between
Ó Society of Surgical Oncology 2020 First Received: 17 December 2019 Y. W. Koh, MD, PhD e-mail: [email protected]
the two groups (13.6% in conventional vs. 15.4% in robotic surgery). The mean follow-up time was 4.9 ± 3.4 years, and recurrences were observed in two patients during follow-up without a significant difference between the two groups (4.5% in conventional vs. 3.8% in robotic surgery). Conclusions. Robotic surgery in PPS tumors is feasible through transoral, retroauricular, or combined approaches and provides treatment outcomes comparable to those of conventional open surgery.
Parapharyngeal space (PPS) tumor is a rare disease representing only 0.5% of all head and neck neoplasms and is particularly challenging to treat via surgical approaches due to the anatomical complexity of PPS. Careful preoperative assessment is necessary to identify the optimal surgical approach to completely remove the tumor without any neural or vascular complications. A systematic review of 1293 PPS tumor patients revealed that approximately 82% of tumors were benign and 18% were malignant.1 Salivary gland (45%) and neurogenic tumors (40%) were the most common types of benign PPS
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