Open AccessNeck Dissection Timing in Transoral Robotic or Laser Microsurgery in Oropharyngeal Cancer: A Systematic Review
Author(s) -
Ramchandani Jai Parkash,
Brunet Aina,
Skalidi Nikoleta,
Faulkner Jack,
Rovira Aleix,
Simo Ricard,
Jean JeanPierre,
Arora Asit
Publication year - 2022
Publication title -
oto open
Language(s) - English
Resource type - Journals
ISSN - 2473-974X
DOI - 10.1177/2473974x221131513
Subject(s) - medicine , neck dissection , transoral robotic surgery , surgery , transoral laser microsurgery , dissection (medical) , microsurgery , head and neck cancer , cochrane library , fistula , cohort study , cancer , randomized controlled trial , radiation therapy
Objective This review assesses the effect on intra‐ and postoperative patient outcomes of the timing of neck dissection in relation to transoral surgery. Outcome measures include postoperative bleeding, intra‐ and postoperative fistula formation, and disease‐specific and overall survival. Data Sources A search was conducted across the MEDLINE, Embase, US National Library of Medicine, and Cochrane databases with search terms in July 2021. Review Methods Articles that conformed with specified inclusion criteria were included. Included articles were scanned for bias with the ROBINS‐I tool. Results Nineteen articles were selected for qualitative analysis, including 546 patients who had neck dissection in conjunction with transoral robotic surgery/transoral laser microsurgery (TORS/TLM). Seventy‐one (18%) patients had neck dissection prior to TORS/TLM, 39 (10%) had neck dissection performed after TORS/TLM, and 281 (72%) had concurrent procedures. In patients with neck dissection before TORS/TLM, 3% experienced major postoperative bleeding, and fistula rates were 0%. In the cohort with neck dissection after TORS/TLM, 3% experienced minor postoperative hemorrhage, and 8% had intraoperative fistulae. In the concurrent cohort of patients, 1% had major postoperative bleeds and 0.3% had minor bleeds, while 4% developed intraoperative fistulas and 0.3% developed postoperative fistulas. Conclusion Current evidence indicated that there appears to be no correlation between timing of neck dissection and complications. This systematic review found insufficient data to comment on whether the timing of neck dissection in relation to TORS/TLM affects the outcomes of patients.