OP193: Transoral robotic retropharyngeal lymph node dissection with or without lateral oropharyngectomy

Abstract

Purpose Retropharyngeal lymph node (RPLN) metastases can occur from advanced head and neck malignancies, most commonly in pharyngeal carcinomas. Surgical access to this group of lymph nodes can be challenging. Considering the more aggressive conventional approach methods to access the RPLN, there is an increasing need for lesser invasive approach methods. Applying Transoral robotic surgery (TORS) to access the RPLN has never been reported in the literature. The purpose of this study was to describe our experience with transoral robotic RPLN dissection for oropharyngeal and hypopharyngeal squamous cell carcinomas. Materials and methods We conducted a retrospective review of TORS cases performed at Severance Hospital, a tertiary care medical center from December 2011 to July 2012. Demographic, clinicopathological, and treatment characteristics were abstracted from the medical record as well as complications. The results were analyzed descriptively. Results A total of five TORS procedures with transoral robotic RPLN dissection have been performed at Severance Hospital. Of these, four patients were treated for oropharyngeal squamous cell carcinoma (OPSCC) and one for hypopharyngeal squamous cell carcinoma (HPSCC). The mean operation time for TORS including the robotic RPLN dissection was 84 ± 18.5 min. The operation time included time for docking of the robotic arms (4.8 ± 1.3 min), console working time for primary tumor removal (50 ± 8.9 min) and console working time for RPLN dissection (29.2 ± 9.4 min). Estimated average blood loss during the course of the operation was 11.2 ± 1.5 mL. The median number of retropharyngeal nodes removed was 1 (range 1–2). All but one case revealed positive RPLN. Extracapsular extension was present in 2 (40%) of the specimens. No patients experienced complications related to the transoral robotic RPLN dissection. Conclusion Transoral robotic RPLN dissection is a feasible approach for accessing retropharyngeal lymph nodes. This particular operative technique can serve as a minimal invasive surgery in removing pathologic RPLNs.