Transoral robotic surgery (TORS) for head and neck squamous cell carcinoma: healing by secondary intention, local flap or free flap

Background: The goal of any oncological therapy should be to achieve long-term disease-free survival while minimising acute and late toxicities. One of the goals of transoral robotic surgery (TORS) resection is to obtain negative margins around the primary tumour with minimal functional morbidity. The aim of this study was to assess the functional morbidity of TORS and evaluate the post-operative pain and functional outcomes 6 months after TORS for head and neck squamous cell carcinoma (SCC) in reconstructed and non-reconstructed patients. Methods: We retrospectively reviewed 64 patients with head and neck SCCs resected by TORS from 2008 to December 2017 in our institution. The tumour localisation, pathologic T classification, defect size, reconstructive method, wound healing time, complications, post-operative pain and functional outcomes at 6 months were statistically evaluated (Table 1). Results: Fifty-four resections healed by secondary intention, and 4 patients were reconstructed with a local flap and 6 with a free flap. No flap loss was encountered, while two cases of flap dehiscence that needed surgical revision and one case of partial necrosis were recorded. Eight patients had post-operative oral bleeding from the primary tumour resection field with an average bleeding time of 6.2 days. All bleeding occurred in patients with secondary healing of the defect after tumour excision, while no oral bleeding was recorded in patients with flap reconstructions. The pain scores in the first 3 post-operative days were 8 ± 1.2 for the secondary healing wounds and 6.2 ± 1.5 for the flap reconstructions. From day 4 to day 10, the mean VAS score was 5.7 ± 1.2 for the secondary healing wounds and 5.5 ± 1.2 for the flap reconstructions. The average wound healing time was 21.3 days in the secondary healing wound patients and 14.5 days in the reconstructed patients. At the 6-month follow-up, 63 out of the 64 patients recovered oral feeding and comprehensive locution, and only one patient experienced severe post-operative dysphagia and needed a permanent tracheostomy tube and percutaneous endoscopic gastrostomy (PEG) feeding. Conclusion: In this retrospective study, the functional morbidity and complications of TORS for head and neck squamous cell carcinoma resection were favourable in reconstructed and non-reconstructed patients. Level of Evidence: Level III, therapeutic study.