Timing of neck dissection in patients undergoing transoral robotic surgery for head and neck cancer

• Published in: European journal of surgical oncology 2015-06, Vol.41 (6), p.773-778
• Main Authors: Möckelmann, N, Busch, C.-J, Münscher, A, Knecht, R, Lörincz, B.B
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; Cutaneous Fistula - etiology; Female; Fistula - etiology; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - surgery; Head and neck squamous cell carcinoma (HNSCC); Hematology, Oncology and Palliative Medicine; Hematoma - etiology; Humans; Intraoperative Complications - etiology; Length of Stay; Lymphatic Metastasis; Male; Middle Aged; Mouth; Neck; Neck dissection; Neck Dissection - adverse effects; Neck Dissection - methods; Nodal yield; Pharyngeal Diseases - etiology; Pharyngeal fistula; Postoperative Complications - etiology; Postoperative Hemorrhage - etiology; Prospective Studies; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Seroma - etiology; Surgery; Time Factors; Transoral robotic surgery (TORS)
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2015.02.002

Abstract Background Oncologic transoral robotic surgery (TORS) requires in most cases the concurrent or staged surgical treatment of the regional lymph nodes in the neck as well. The purpose of this study was to determine whether the timing of the regional lymphadenectomy (neck dissection) has an impact on the surgical outcomes and on the complication rates. Methods Single-institution, prospective case series with internal control group. Twenty-one patients underwent TORS and appropriate neck dissection concurrently (control group), while 20 patients underwent neck dissection in a timely staged fashion, 8.4 days (median; range, 3–28 days) following their TORS procedure (experimental group). Outcome measures included nodal yield, intraoperative pharyngocervical fistula formation, postoperative fistula formation, postoperative bleeding from the primary and from the neck dissection site, haematoma, seroma, and infection. Results Nodal yield values, as the oncologic quality indicator of a neck dissection, were comparable in the experimental and in the control group. Complication rates did not differ between the groups: intraoperative and postoperative fistula formation, postoperative bleeding, haematoma and seroma rates were similarly low in the two groups. There was no infection in either group. Conclusions In the present cohort of 41 TORS-patients, the timing of neck dissection did not make a significant difference in the outcomes. We suggest therefore that aspiring and established TORS-teams do not restrict their appropriate indications due to robotic slot and theatre time constraints, but perform each indicated TORS-case as soon as possible within their given systems, even if the neck dissections cannot be done on the same day.