OP185: Surgical feasibility and oncologic safety of robot-assisted neck dissection followed by transoral robotic surgery (TORS) in head and neck cancer

Abstract

Introduction Endoscopic head and neck surgery (transoral laser microsurgery & transoral robotic surgery (TORS)) is no longer novel technique in head and neck cancer (HNC) treatment. But, there is few effort for minimally invasive neck dissection in HNC. We have tried to verify the possibility of Robot-assisted neck dissection (RAND) in HNC. We aimed to evaluate the surgical feasibility and oncologic safety of RAND followed by TORS, which is expected to maximize the posttreatment cosmesis and functional outcome, in HNC. Methods Thirty-four patients who underwent TORS following RAND via a Modified facelift or retroauricular approach in cN0 or cN + HNC were enrolled. The operation time, amount and duration of drainage, length of hospital stay, complications, number of retrieved lymph nodes, satisfaction scores, and nodal recurrence were evaluated. Results The primary tumor sites were found within the oropharynx for 20 patients (15 tonsil, three tongue-base, two soft palate), the hypopharynx for eight patients, and the supraglottis for six patient. Twenty-two cases of MRND including levels I or II to V, fifteen cases of SND from level II to IV (LND), and three cases of SND from level I to III (SOND) were accomplished. Bilateral RAND were performed in six patients. The free flap reconstructions were performed in 7 cases. The mean total operating time for ND was 242 min (MRND), 199 min (LND), and 165 min (SOND), respectively and the mean postoperative hospital stay was 11.45 ± 5.2 days. The amount of postoperative drainage was 251.82 ± 131.2 mL, and the drainage duration was 5.51 ± 3.4 days. An average of 39.6(MRND), 22.1(LND), and 36.5(SOND) lymph nodes was retrieved respectively. There were four postoperative seroma, one postoperative bleeding, two chyle leakage, 1 Honer’s syndrome, and 6 temporary mouth corner deviation. Orocervical fistula did not occur. Twenty patients underwent postoperative chemoradiation and eight patients underwent postoperative radiation. During the follow-up period (mean of 10.3 months), all patients were alive without locoregional recurrence. All patients were extremely satisfied with their cosmetic results after the operation. Conclusions RANDs followed by TORS were feasible and showed a clear cosmetic benefit. Longer operation time remains the drawback of this procedure. The safety, functional, and oncologic outcome of the procedure should be verified with larger number of patients and longer follow up period.