Frontiers in oncology · 2026
Preventing bleeding and surgical complications in transoral robotic surgery for the oropharynx: results of a global survey.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Russo Elena, Pace Gian Marco, Costantino Andrea, Iannella Giannicola, Sampieri Claudio, De Virgilio Armando
Аннотация
OBJECTIVE: This study aimed to characterize global practice patterns in transoral robotic surgery (TORS), with particular attention to differences across oropharyngeal subsites.
METHODS: We conducted a 40-item international web-based survey of TORS-experienced head and neck surgeons (April-June 2024). The questionnaire covered demographics, robotic platforms, bleeding prevention, airway management, postoperative care, and reconstruction. Descriptive statistics summarized responses. Base of tongue resections were compared with lateral oropharyngectomies using χ² or Fisher's exact tests, with Cramér's V for effect sizes; McNemar's test was used for paired binary data.
RESULTS: Sixty-nine surgeons from 22 countries completed the survey (response rate 37.9%), most working in academic centers (73.9%). Prophylactic neck vessel ligation was routinely performed by about 60% of surgeons for both base of tongue and lateral oropharyngectomy, with no significant difference in overall use between subsites. Among surgeons performing ligation, lingual artery ligation was significantly more frequent in base of tongue procedures than in lateral oropharyngectomy (p < 0.001; Cramér's V = 0.46). Routine tracheotomy was uncommon (4-9%) and mainly reserved for selected high-risk cases. Postoperative care varied substantially, with most patients hospitalized for ≥4 days and nasogastric tube use in 58-64% of cases. Local flap reconstruction was significantly more common after lateral oropharyngectomy than base of tongue resection, whereas free flap use did not differ between subsites.
CONCLUSION: Our findings highlight considerable variability in perioperative and intraoperative management strategies for oropharyngeal TORS, reflecting the lack of standardized protocols. Differences in bleeding prevention and reconstructive techniques may be related to the anatomy of specific oropharyngeal subsites, underscoring the need for consensus-building efforts to harmonize TORS patient management.
METHODS: We conducted a 40-item international web-based survey of TORS-experienced head and neck surgeons (April-June 2024). The questionnaire covered demographics, robotic platforms, bleeding prevention, airway management, postoperative care, and reconstruction. Descriptive statistics summarized responses. Base of tongue resections were compared with lateral oropharyngectomies using χ² or Fisher's exact tests, with Cramér's V for effect sizes; McNemar's test was used for paired binary data.
RESULTS: Sixty-nine surgeons from 22 countries completed the survey (response rate 37.9%), most working in academic centers (73.9%). Prophylactic neck vessel ligation was routinely performed by about 60% of surgeons for both base of tongue and lateral oropharyngectomy, with no significant difference in overall use between subsites. Among surgeons performing ligation, lingual artery ligation was significantly more frequent in base of tongue procedures than in lateral oropharyngectomy (p < 0.001; Cramér's V = 0.46). Routine tracheotomy was uncommon (4-9%) and mainly reserved for selected high-risk cases. Postoperative care varied substantially, with most patients hospitalized for ≥4 days and nasogastric tube use in 58-64% of cases. Local flap reconstruction was significantly more common after lateral oropharyngectomy than base of tongue resection, whereas free flap use did not differ between subsites.
CONCLUSION: Our findings highlight considerable variability in perioperative and intraoperative management strategies for oropharyngeal TORS, reflecting the lack of standardized protocols. Differences in bleeding prevention and reconstructive techniques may be related to the anatomy of specific oropharyngeal subsites, underscoring the need for consensus-building efforts to harmonize TORS patient management.