JAMA Otol Logo Orlando 2013 AHNS Meeting Location
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American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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SURGICAL FEASIBILITY AND ONCOLOGIC SAFETY OF ROBOT-ASSISTED NECK DISSECTION FOLLOWED BY TRANSORAL ROBOTIC SURGERY (TORS) IN HEAD AND NECK CANCER

Presentation: S015
Topic: Clinical - Novel Technology
Type: Oral Presentation
Date: Wednesday, April 10, 2013
Session: 04:00 PM - 05:00 PM Robotics
Authors: Hyung Kwon Byeon, MD, Jae Wook Kim, MD, Eun Sung Kim, MD, Hyo Jin Chung, MD, Eun Jung Lee, MD, Hyun Jun Hong, MD, Won Shik Kim, MD, Yoon Woo Koh, MD, PhD, Eun Chang Choi, MD, PhD
Institution(s): 1Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea 2Department of Otolaryngology–Head and Neck Surgery, Soonchunhyang University College of Medicine, Seoul, Korea

 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, 3 tongue-base, 2 soft palate), the hypopharynx for 8 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 4 postoperative seroma, 1 postoperative bleeding, 2 chyle leakage, 1 Honer’s syndrome, and 6 temporary mouth corner deviation. Orocervical fistula didn’t occur. Twenty patients underwent postoperative chemoradiation and 8 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.

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