Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Ann Surg Oncol. 2020 Oct;27(11):4535-4543. doi: 10.1245/s10434-020-08536-0. Epub 2020 May 30.
Benefits and drawbacks of robotic surgical approaches for parapharyngeal space (PPS) tumors remain undetermined. The purpose of this study is to compare surgical outcomes of PPS tumor patients who underwent robotic surgery with those of patients who received conventional surgical treatment.
We retrospectively analyzed clinicopathologic data from 136 patients who underwent surgical removal of PPS tumors via conventional or robotic approaches.
We identified PPS tumors in pre- and poststyloid regions in 87 (64%) and 49 (36%) patients, respectively. There were 48 (35.3%) pleomorphic adenomas, 36 (26.5%) schwannomas, and 24 (17.6%) paragangliomas. Conventional surgical techniques were performed in 83 patients, and robotic surgical approaches were administered to 53 patients. Transcervical-parotid and transcervical approaches were most commonly performed in conventional surgery, while transoral and retroauricular approaches were the preferred surgical methods in robotic surgery for pre- and poststyloid PPS tumors, respectively. Robotic surgery resulted in less estimated blood loss during poststyloid PPS tumor surgery. Postoperative cranial nerve complications were noted in 36 of 83 cases (43.4%) in the conventional surgery group and in 17 of 53 cases (32.1%) in the robotic surgery group. Intraoperative tumor spillage of pleomorphic adenoma showed no significant differences between the two groups (13.6% in conventional vs. 15.4% in robotic surgery). The mean follow-up time was 4.9 ± 3.4 years, and recurrences were observed in two patients during follow-up without a significant difference between the two groups (4.5% in conventional vs. 3.8% in robotic surgery).
Robotic surgery in PPS tumors is feasible through transoral, retroauricular, or combined approaches and provides treatment outcomes comparable to those of conventional open surgery.
机器人手术入路治疗咽旁间隙（PPS）肿瘤的优缺点仍未确定。本研究旨在比较接受机器人手术和传统手术治疗的 PPS 肿瘤患者的手术结果。
我们回顾性分析了 136 例通过传统或机器人方法行 PPS 肿瘤切除术患者的临床病理资料。
我们分别在 87 例（64%）和 49 例（36%）患者中发现了前咽旁区和后咽旁区的 PPS 肿瘤。其中 48 例（35.3%）为多形性腺瘤，36 例（26.5%）为神经鞘瘤，24 例（17.6%）为副神经节瘤。83 例患者采用传统手术技术，53 例患者采用机器人手术入路。传统手术中最常采用经颈腮腺和经颈入路，而机器人手术中经口和耳后入路分别为前、后咽旁区 PPS 肿瘤的首选手术方法。机器人手术在后咽旁 PPS 肿瘤手术中出血量估计较少。83 例常规手术组中有 36 例（43.4%）出现术后颅神经并发症，53 例机器人手术组中有 17 例（32.1%）出现术后颅神经并发症。两组多形性腺瘤术中肿瘤溢漏无显著差异（常规组 13.6%，机器人组 15.4%）。平均随访时间为 4.9±3.4 年，随访期间有 2 例复发，两组间无显著差异（常规组 4.5%，机器人组 3.8%）。
机器人手术治疗 PPS 肿瘤是可行的，可通过经口、耳后或联合入路进行，治疗效果可与传统开放手术相媲美。
