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. 2017 Mar 14;46(1):20.
doi: 10.1186/s40463-017-0196-0.

Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis

Vincent L Biron  1   2 , Daniel A O'Connell  3   4 , Brittany Barber  3 , Jessica M Clark  3 , Colin Andrews  5 , Caroline C Jeffery  3 , David W J Côté  3 , Jeffrey Harris  3   4 , Hadi Seikaly  3   4
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Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis

Vincent L Biron et al. J Otolaryngol Head Neck Surg. .

Abstract

Background: 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.

Methods: Prospectively 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.

Results: Patients 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.

Conclusion: TORS 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.

Keywords: Human papillomavirus; Mandibulotomy; Oropharyngeal cancer; Radial forearm free flap; Transoral robotic surgery.

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Figures

Fig. 1
Fig. 1
Summary of oropharyngeal cancer patients selected for inclusion in this study
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