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Staged neck dissection prior to transoral robotic surgery for oropharyngeal cancer: does it reduce post-operative complication rates? A multi-centre study of 104 patients

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Transoral robotic surgery (TORS) has become increasingly recognised as a safe and effective treatment for early oropharyngeal squamous cell carcinoma, often performed in conjunction with neck dissection (ND) and vessel ligation. It has been proposed that performing the neck dissection in a staged fashion prior to TORS results in low rates of transoral haemorrhage and pharyngocutaneous fistula, and may aid in TORS patient selection by eliminating patients who would require multi-modality treatment based on nodal pathology. This study aims to assess the effect of staged neck dissection with TORS in mitigating pharyngocutaneous fistulae and post-operative haemorrhage as well as the impact of staged ND on TORS patient selection.

Methods

A retrospective cohort analysis was performed of patients undergoing staged ND with intent to proceed to TORS at two Australian hospitals between 2014 and 2022. Incidence of post-operative haemorrhage and pharyngocutaneous fistula and length of inpatient stay was identified. The number of patients who did not proceed to TORS was recorded.

Results

One hundred and four patients were identified who underwent staged neck dissection with an intention to proceed to TORS. Six patients did not proceed to TORS following pathological assessment of the neck dissection specimen and ninety-eight patients (91 primary, 7 salvage) underwent TORS. There were six cases of secondary haemorrhage (one major, two intermediate and three minor). There were no cases of pharyngocutaneous fistula.

Conclusion

Staged neck dissection prior to TORS results in low rates of haemorrhage and pharyngocutaneous fistula and can improve TORS patient selection.

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Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia

    Megan Blom, Henry Zhang, Benjamin Dixon & Matthew Magarey

  2. Pinnacle Surgery, Epworth Richmond Hospital, Melbourne, VIC, Australia

    Anne Tescher, Benjamin Dixon & Matthew Magarey

  3. Department of Surgery, University of Melbourne, Melbourne, VIC, Australia

    Benjamin Dixon

  4. Department of Medical Education, University of Melbourne, Melbourne, VIC, Australia

    Matthew Magarey

  5. Bart’s Health NHS Trust, London, United Kingdom

    Henry Zhang

Authors
  1. Megan Blom
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  2. Henry Zhang
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  3. Anne Tescher
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  4. Benjamin Dixon
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  5. Matthew Magarey
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Contributions

Conception and design: MB, HZ, BD, MM; Administrative support: MB; Provision of study materials or patients: all authors; Collection and assembly of data: all authors; Data analysis and interpretation: MB, MM; Writing: MB, MM; Final approval of manuscript: all authors.

Corresponding author

Correspondence to Megan Blom.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Peter MacCallum Cancer Centre Ethics Committee (EC00235).

Consent to participate

Individual consent for this retrospective analysis was waived.

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Blom, M., Zhang, H., Tescher, A. et al. Staged neck dissection prior to transoral robotic surgery for oropharyngeal cancer: does it reduce post-operative complication rates? A multi-centre study of 104 patients. Eur Arch Otorhinolaryngol 280, 5067–5072 (2023). https://doi.org/10.1007/s00405-023-08108-4

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  • DOI: https://doi.org/10.1007/s00405-023-08108-4

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