Objectives: Since FDA approval of TORS, the publication of TORS related complications has not equaled reports of oncological outcomes. It is important to know the incidence and severity of complications associated with TORS when counseling patients regarding modality of treatment especially when nonsurgical treatment options are available.  The objective of this study was to report the complications occurring following TORS and to identify the factors predictive of complications.   

Methods: Following IRB approval a retrospective analysis of all TORS operations at our institution was carried out. Data was collected on patient and tumor characteristics including age, comorbidities, tumor pathology, TNM stage and the extent of resection. Postoperative complications within 45 days were collected and graded with the Clavien-Dindo system. The severity of a complication is assigned a grade, 1 to 5, based on the most invasive intervention required to correct it. Complications were categorized into groups: all complications, not related to TORS and TORS related. Grades 1 and 2 complications were classified as minor and grades 3,4,5 classified as major.  Chi-square and Fisher’s exact tests were used for the test of association between patients with and without a complication.

Results: 121 TORS operations were carried out between June 2010 and August 2015. 77% were male, with a median age of 57. There were 92 primary tumor resections, 10 second head and neck primary resections, 12 salvage procedures and 7 other indications. Surgical resection involved 1, 2 or >3 sub-sites in 36%, 28% and 36% patients, respectively.  

Overall, there were 113 complications (35 TORS related, 78 non-TORS related) that occurred in 57 patients (47%). A major complication occurred in 22 patients, with 2 patients having both a TORS related and non-TORS related complication. 19 patients had a TORS related major complication and 5 patients experienced a non-TORS related major complication.

Statistical analysis showed age over 60 (p=0.05) and a larger surgical resection (p=0.03) were associated with a major complication (Figure 1). Age over 60 (p=0.02), the extent of surgical resection (p=0.02) and AJCC stage III/IV (p=0.04) were associated with a TORS related major complication. No factors were associated with a non-TORS related major complication.

There was 1 perioperative death (grade 5 complication) due to severe congestive cardiac failure.

7 patients had a complications requiring ICU care (grade 4) of which 6 were TORS related (3 cases of aspiration and 3 hemorrhages) and 1 non-TORS related (neck infection following neck dissection). Grade 3 complications occurred in 19 patients of which 15 were TORS related (11 gastrostomy placements, 4 hemorrhages and 1 temporary tracheostomy) and 3 non-TORS related complications (3 neck wound hematomas).

Conclusions: 18% (22/121) of patients experienced a Clavien-Dindo grade 3, 4 or 5 complication after TORS. Age over 60 years and a larger extent of surgical resection were the two significant factors predictive of complications following TORS.  

Figure 1