Abstract
BackgroundThe resection of large oropharyngeal tumors traditionally involves a lip-splitting mandibulotomy for adequate margin visualization and free flap reconstruction of the surgical defect. Transoral robotic surgery (TORS) has emerged as a technique that can resect large and complex oropharyngeal tumors, avoiding a lip-splitting approach. The aim of this study is to compare the lip-splitting mandibulotomy approach versus TORS for the management of advanced stage oropharyngeal carcinomas.MethodsProspectively collected data from 18 patients with advanced stage oropharyngeal squamous cell carcinoma (OPSCC) who received TORS with radial forearm free flap reconstruction (RFFF) was compared to a matched cohort of 39 patients who received a lip-splitting mandibulotomy and RFFF. Patients were matched for stage, p16 positivity, smoking, age and gender. Length of hospital stay (LOHS), tracheostomy decanulation time, operative time, surgical margin status, and post-operative complications were compared between groups.ResultsPatients who received TORS with RFFF had a significantly lower mean LOHS, compared to patients who were treated by lip-splitting mandibulotomy and RFFF (14.4 vs 19.7 days, p = 0.03). No significant differences were seen between groups in terms of operative time, tracheostomy decannulation time, margin positivity and post-operative complications.ConclusionTORS with radial forearm free flap reconstruction is a safe, effective and cost-saving alternative to the lip-splitting mandibulotomy approach for the treatment of advanced stage OPSCC.
Highlights
The resection of large oropharyngeal tumors traditionally involves a lip-splitting mandibulotomy for adequate margin visualization and free flap reconstruction of the surgical defect
Patient data All Oropharyngeal squamous cell carcinoma (OPSCC) patients who received Transoral robotic surgery (TORS) and radial forearm free flap reconstruction (RFFF) from May 2015-July 2016 or lip-splitting mandibulotomy with Radial forearm free flap (RFFF) from January 2006-July 2016 at the University of Alberta were included in the study
Patient characteristics From May 2015 to July 2016, 38 patients received TORS at the University of Alberta, of which 18 received a radial forearm free flap (RFFF) reconstruction and were included in this study. These patients were compared to a historical cohort of 76 OPSCC patients who were treated with primary surgery using a lip-splitting mandibulotomy approach and RFFF (Fig. 1)
Summary
The resection of large oropharyngeal tumors traditionally involves a lip-splitting mandibulotomy for adequate margin visualization and free flap reconstruction of the surgical defect. Transoral robotic surgery (TORS) has emerged as a technique that can resect large and complex oropharyngeal tumors, avoiding a lip-splitting approach. The aim of this study is to compare the lip-splitting mandibulotomy approach versus TORS for the management of advanced stage oropharyngeal carcinomas. The treatment of advanced stage OPSCC has been a subject of controversy in recent years, as comparable survival outcomes can be achieved with either chemoradiation or primary surgery for HPV-positive tumors. The increasing use of transoral robotic surgery (TORS) since its FDA approval in 2009 has paralleled a paradigm shift towards primary surgical treatment of OPSCC [9, 21,22,23,24,25].
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