Möckelmann N, Busch C-J, Münscher A, Knecht R, Lörincz B B
Department of Otorhinolaryngology, Head & Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Head and Neck Cancer Centre of the University Cancer Centre Hamburg (UCCH), Martinistr. 52, D-20246 Hamburg, Germany.
Department of Otorhinolaryngology, Head & Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Head and Neck Cancer Centre of the University Cancer Centre Hamburg (UCCH), Martinistr. 52, D-20246 Hamburg, Germany.
Eur J Surg Oncol. 2015 Jun;41(6):773-8. doi: 10.1016/j.ejso.2015.02.002. Epub 2015 Feb 17.
Oncologic transoral robotic surgery (TORS) requires in most cases the concurrent or staged surgical treatment of the regional lymph nodes in the neck as well. The purpose of this study was to determine whether the timing of the regional lymphadenectomy (neck dissection) has an impact on the surgical outcomes and on the complication rates.
Single-institution, prospective case series with internal control group. Twenty-one patients underwent TORS and appropriate neck dissection concurrently (control group), while 20 patients underwent neck dissection in a timely staged fashion, 8.4 days (median; range, 3-28 days) following their TORS procedure (experimental group). Outcome measures included nodal yield, intraoperative pharyngocervical fistula formation, postoperative fistula formation, postoperative bleeding from the primary and from the neck dissection site, haematoma, seroma, and infection.
Nodal yield values, as the oncologic quality indicator of a neck dissection, were comparable in the experimental and in the control group. Complication rates did not differ between the groups: intraoperative and postoperative fistula formation, postoperative bleeding, haematoma and seroma rates were similarly low in the two groups. There was no infection in either group.
In the present cohort of 41 TORS-patients, the timing of neck dissection did not make a significant difference in the outcomes. We suggest therefore that aspiring and established TORS-teams do not restrict their appropriate indications due to robotic slot and theatre time constraints, but perform each indicated TORS-case as soon as possible within their given systems, even if the neck dissections cannot be done on the same day.
大多数情况下，肿瘤经口机器人手术（TORS）还需要同时或分阶段对颈部区域淋巴结进行手术治疗。本研究的目的是确定区域淋巴结清扫术（颈部清扫术）的时机是否会影响手术结果和并发症发生率。
单机构、有内部对照组的前瞻性病例系列研究。21例患者同时接受TORS和适当的颈部清扫术（对照组），而20例患者在TORS手术后8.4天（中位数；范围3 - 28天）及时分阶段进行颈部清扫术（实验组）。观察指标包括淋巴结收获量、术中咽颈瘘形成、术后瘘形成、原发部位和颈部清扫部位术后出血、血肿、血清肿和感染。
作为颈部清扫术肿瘤学质量指标的淋巴结收获量值，在实验组和对照组中具有可比性。两组之间的并发症发生率没有差异：两组的术中及术后瘘形成、术后出血、血肿和血清肿发生率同样较低。两组均无感染发生。
在本队列的41例TORS患者中，颈部清扫术的时机对结果没有显著影响。因此，我们建议，有抱负的和成熟的TORS团队不要因机器人手术时间和手术室时间限制而限制其合适的适应症，而是在其既定系统内尽快对每例有适应症的TORS病例进行手术，即使颈部清扫术不能在同一天进行。
