Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

• Published in: Head & neck 2022-05, Vol.44 (5), p.1246-1254
• Main Authors: Barrette, Louis‐Xavier, De Ravin, Emma, Carey, Ryan M., Mady, Leila J., Cannady, Steven B., Brody, Robert M.
• Format: Article
• Language: English
• Subjects: Cutaneous Fistula - etiology; Cutaneous Fistula - surgery; Fistulae; Forearm; Free Tissue Flaps; Head & neck cancer; Head and Neck Neoplasms - surgery; head and neck surgery; Hemorrhage; Humans; microvascular free flap; Patients; reconstruction; Reconstructive Surgical Procedures - adverse effects; Robotic surgery; Robotic Surgical Procedures - adverse effects; Surgical outcomes; Systematic review; transoral robotic surgery; Tumors
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.26998

We performed a systematic review to characterize reconstructive modalities and postoperative surgical outcomes following TORS resection. A search of the PubMed, SCOPUS, and EMBASE databases was conducted to identify studies describing patients undergoing reconstruction of TORS defects. Twenty‐six studies met inclusion criteria, consisting of 260 patients who underwent TORS resection followed by reconstruction. Twenty‐one studies reported tumor classification information, with TORS performed for 44 (23.0%) T1, 86 (45.0%) T2, 33 (17.3%) T3, and 28 (14.7%) T4 tumors. Eighteen distinct reconstructive modalities were described in the studies identified, including nine unique free flap types. The most commonly performed reconstruction was the radial forearm free flap (RFFF), accounting for 121/260 (46.5%) of reconstructions performed. Reported surgical complications included 5 pharyngocutaneous fistulae, 13 hemorrhagic complications, 24 infectious complications, and 5 free flap failures. Our findings demonstrate favorable surgical outcomes but minimal quantitative functional data to compare reconstructive options following TORS.