John Gleysteen1, Scott Troob1, Tyler Light1, Daniel Brickman1, Daniel Clayburgh1, Peter Andersen1, Neil Gross2. 1. Departments of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, OR, United States. 2. Department of Head and Neck Surgery, M.D. Anderson Cancer Center, Houston, TX, United States. Electronic address: ngross@mdanderson.org.
Abstract
BACKGROUND: Transoral robotic-assisted surgery (TORS) is increasingly utilized in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). Postoperative bleeding is a significant and potentially fatal complication of TORS. Prophylactic ligation of ipsilateral external carotid artery (ECA) branches is a recognized strategy to reduce postoperative bleeding risk. We examined the incidence and sequelae of postoperative oropharyngeal bleeding with and without routine ECA ligation. METHODS: OPSCC patients treated with TORS between 2010 and 2015 with minimum 30days follow up were included. Clinicopathological data, operative details, and postoperative course were abstracted for analysis. Cases of postoperative bleeding were classified as Minor, Intermediate, Major, and Severe. The incidence and severity of bleeding was compared between patients treated with and without prophylactic ECA ligation. RESULTS: Bleeding after TORS was documented in 13/201 (6.5%) patients. The majority of bleeding episodes were observed among anticoagulated or previously radiated patients. By surgeon preference, 52 patients had prophylactic ECA ligation during neck dissection while the remaining 149 patients did not. There was no significant difference in overall incidence of postoperative bleeding between patients with prophylactic ECA ligation (3/52, 5.8%) and patients without (10/149, 6.7%) [p=0.53]. However, severe bleeding complications (4, 2.0%) were only observed in patients without prophylactic ligation. CONCLUSION: A small but meaningful risk of bleeding after TORS for OPSCC exists, particularly among anticoagulated or previously radiated patients. Prophylactic ECA ligation did not significantly impact the overall incidence of postoperative bleeding but may reduce the risk of severe (life-threatening) bleeding.
BACKGROUND: Transoral robotic-assisted surgery (TORS) is increasingly utilized in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). Postoperative bleeding is a significant and potentially fatal complication of TORS. Prophylactic ligation of ipsilateral external carotid artery (ECA) branches is a recognized strategy to reduce postoperative bleeding risk. We examined the incidence and sequelae of postoperative oropharyngeal bleeding with and without routine ECA ligation. METHODS: OPSCC patients treated with TORS between 2010 and 2015 with minimum 30days follow up were included. Clinicopathological data, operative details, and postoperative course were abstracted for analysis. Cases of postoperative bleeding were classified as Minor, Intermediate, Major, and Severe. The incidence and severity of bleeding was compared between patients treated with and without prophylactic ECA ligation. RESULTS:Bleeding after TORS was documented in 13/201 (6.5%) patients. The majority of bleeding episodes were observed among anticoagulated or previously radiatedpatients. By surgeon preference, 52 patients had prophylactic ECA ligation during neck dissection while the remaining 149 patients did not. There was no significant difference in overall incidence of postoperative bleeding between patients with prophylactic ECA ligation (3/52, 5.8%) and patients without (10/149, 6.7%) [p=0.53]. However, severe bleeding complications (4, 2.0%) were only observed in patients without prophylactic ligation. CONCLUSION: A small but meaningful risk of bleeding after TORS for OPSCC exists, particularly among anticoagulated or previously radiatedpatients. Prophylactic ECA ligation did not significantly impact the overall incidence of postoperative bleeding but may reduce the risk of severe (life-threatening) bleeding.
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