Transoral Robotic Surgery for Head and Neck Cancer: Practical Considerations
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SURGERY
Transoral Robotic Surgery for Head and Neck Cancer: Practical Considerations Enrique Cadena-Piñeros 1,2,3
&
Andrey Moreno Torres 1,4
&
Juliana Restrepo 5,6
&
Judith Vásconez Escobar 1,6
Accepted: 27 October 2020 # Springer Nature Switzerland AG 2020
Abstract Transoral robotic surgery (TORS) has gained acceptance for treating a variety of head and neck benign and malignant pathologies. Some TORS advantages are great 3D visualization, shorter operative times, increased range of movement in narrow spaces, getting a complete pathological specimen, and improved life quality (LQ), resulting in well-validated functionality and oncological outcomes. This is a retrospective case series of patients treated with TORS between 2013 and 2019. Preoperative, intraoperative, and postoperative variables were collected. Descriptive statistics were used to report medians and ranges for continuous variables. The number of cases and percentages were used to describe categorical variables. Fifteen patients have been treated for oncological pathologies with TORS in two Colombian health centers. Lateral oropharyngectomy was the most common surgery comprising 80% of surgeries. Three patients receiving this surgery also had one tongue base resection, one soft palate resection, and one retromolar trigone resection. Bilateral lingual and palatine tonsillectomy was performed in 13.3% of patients and supraglottic laryngectomy in 6.7%. Twelve patients (80%) had secondary wound healing, and three (20%) needed free flap reconstruction. After reviewing these initial experiences, we concluded that TORS is a versatile procedure for resection of tumor located in the oropharynx, supraglottis, and retromolar trigone. TORS is also useful for the reconstruction of subsequent defects with free flaps. We believed that some practical considerations must be published to help head and neck surgeons during the preoperative, intraoperative, and postoperative stages. Keywords Robotics . Head and neck neoplasms . Oropharyngeal neoplasms . Margins of excision
Introduction Oropharyngeal cancer treatment is still controversial. Surgery and chemoradiation are similar in terms of oncologic safety and survival rates [1]. However, chemoradiation was associated with fewer morbidity and better functional outcomes
when compared to open surgery [2], which requires surgical disruption of healthy maxillofacial musculoskeletal structures to gain access to the tumor [1, 3]. Radiation therapy late effects such as swallowing dysfunction, fibrosis, xerostomia, and radio-induced neoplasms have raised awareness, leading to an increase in minimally invasive trans-oral surgeries.
This article is part of the Topical Collection on Surgery * Enrique Cadena-Piñeros [email protected]
2
Department of Otorhinolaryngology, Universidad Nacional de Colombia and Hospital Universitario Nacional de Colombia, Bogotá D.C., Colombia
3
Department of Otorhinolaryngology and Head and Neck, Clínica de Marly, Bogotá D.C., Colombia
4
Department of Surgery, Clínica del Coun
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