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Saturday, September 29, 2018: 9:00 AM
Head and neck squamous cell carcinoma (SCC) can be treated with similar oncologic outcomes either with primary chemoradiation therapy (CRT) or transoral robotic surgery (TORS) with or without adjuvant CRT(1). However, TORS offers several functional advantages. In locoregionally advanced patients TORS must be combined with flap reconstruction to restore function. From 2008 to December 2017, 514 TORS procedures were performed in our institution: 159 were tumor resections and 64 of them were SCC.
Aim of the study is to assess post-operative complications, pain and functional outcome at 6 months after TORS for head and neck SCC, in reconstructed and non-reconstructed patients.
We retrospectively evaluated sixty-four patients with SCC treated with TORS between January 2008 and December 2017. Site of the SCC, TNM staging, reconstructive method, time to wound healing, complications and 6 months functional outcomes have been evaluated.
The primary tumour was classified as cT1(22/64; 34.3%), cT2(25/64; 39%), cT3(8/64; 12.5%) and cTx(9/64; 14%). The primary tumor arose in the base of the tongue in 28 patients (43.7%), tonsils in 28 patients (43.7%), soft palate in 2 (3.1%), posterior pharyngeal wall in 3(4.6%) and supraglottis in 3 (4.6%). Fifty-four resections healed by secondary intention, 4 patients were reconstructed with a local flap (one facial artery myo-mucosal flap FAMM, one buccal aetery myo-mucosal flap, one temporalis myofascial flap TMF and one infrahyoid flap) and 6 underwent a reconstruction with a free antero lateral thigh flap ALT. Flap reconstruction was performed in selected patients with exposure of internal carotid artery, soft palate resection or oropharyngeal sphincter resection(2). Free flaps were carefully tailored according to Caliceti's “standard template"(3) method before their inset and robotic arms were used to inset the flap in 5 patients. No flap loss was encountered, whilst two flap dehiscence (1 FAMM and 1 ALT) that needed a surgical revision and a TMF partial necrosis were recorded. Eight patients had post-operative bleeding from primary tumor resection field, oral bleeding had a mean of 6.2 days in secondary healing wounds. Mean time to complete wound healing was 21.3 days in secondary healing wounds and 14.5 in flap reconstructed patients. At a 6 months follow up the patients recovered oral feeding and comprehensive locution, only one patient (pT3N2b of BOT invading tonsil and soft palate with ALT reconstruction) experienced a post-operative severe dysphagia and needed a permanent tracheostomy tube and percutaneous endoscopic gastrostomy PEG feeding.
Finally, in selected patients TORS improves the long term quality of life,compared to non surgical treatments with the same oncologic outcomes. Flap reconstruction allows to extend the benefits of TORS to locally advanced cancer patients.
REFERENCES
1.Ward MC, Koyfman SA. Transoral robotic surgery: The radiation oncologist’s perspective. Oral Oncol 2016;60:96–102.
2. Hatten KM, Brody RM, Weinstein GS,et al. Defining the role of free flaps for transoral robotic surgery. Ann Plast Surg. 2018 Jan;80(1):45-49.
3. Caliceti U, Piccin O, Sgarzani R et al. Surgical strategies based on standard templates for microsurgical reconstruction of oral cavity and oropharynx soft tissue: a 20 years' experience. Microsurgery. 2013 Feb;33(2):90-104.
Aim of the study is to assess post-operative complications, pain and functional outcome at 6 months after TORS for head and neck SCC, in reconstructed and non-reconstructed patients.
We retrospectively evaluated sixty-four patients with SCC treated with TORS between January 2008 and December 2017. Site of the SCC, TNM staging, reconstructive method, time to wound healing, complications and 6 months functional outcomes have been evaluated.
The primary tumour was classified as cT1(22/64; 34.3%), cT2(25/64; 39%), cT3(8/64; 12.5%) and cTx(9/64; 14%). The primary tumor arose in the base of the tongue in 28 patients (43.7%), tonsils in 28 patients (43.7%), soft palate in 2 (3.1%), posterior pharyngeal wall in 3(4.6%) and supraglottis in 3 (4.6%). Fifty-four resections healed by secondary intention, 4 patients were reconstructed with a local flap (one facial artery myo-mucosal flap FAMM, one buccal aetery myo-mucosal flap, one temporalis myofascial flap TMF and one infrahyoid flap) and 6 underwent a reconstruction with a free antero lateral thigh flap ALT. Flap reconstruction was performed in selected patients with exposure of internal carotid artery, soft palate resection or oropharyngeal sphincter resection(2). Free flaps were carefully tailored according to Caliceti's “standard template"(3) method before their inset and robotic arms were used to inset the flap in 5 patients. No flap loss was encountered, whilst two flap dehiscence (1 FAMM and 1 ALT) that needed a surgical revision and a TMF partial necrosis were recorded. Eight patients had post-operative bleeding from primary tumor resection field, oral bleeding had a mean of 6.2 days in secondary healing wounds. Mean time to complete wound healing was 21.3 days in secondary healing wounds and 14.5 in flap reconstructed patients. At a 6 months follow up the patients recovered oral feeding and comprehensive locution, only one patient (pT3N2b of BOT invading tonsil and soft palate with ALT reconstruction) experienced a post-operative severe dysphagia and needed a permanent tracheostomy tube and percutaneous endoscopic gastrostomy PEG feeding.
Finally, in selected patients TORS improves the long term quality of life,compared to non surgical treatments with the same oncologic outcomes. Flap reconstruction allows to extend the benefits of TORS to locally advanced cancer patients.
REFERENCES
1.Ward MC, Koyfman SA. Transoral robotic surgery: The radiation oncologist’s perspective. Oral Oncol 2016;60:96–102.
2. Hatten KM, Brody RM, Weinstein GS,et al. Defining the role of free flaps for transoral robotic surgery. Ann Plast Surg. 2018 Jan;80(1):45-49.
3. Caliceti U, Piccin O, Sgarzani R et al. Surgical strategies based on standard templates for microsurgical reconstruction of oral cavity and oropharynx soft tissue: a 20 years' experience. Microsurgery. 2013 Feb;33(2):90-104.