Ionna Fraco, Guida Agostino, Califano Luigi, Motta Gaetano, Salzano Giovanni, Pavone Ettore, Aversa Corrado, Longo Francesco, Villano Salvatore, Ponzo Ludovica Marcella, Franco Pierluigi, Losito Simona, Buonaguro Franco Maria, Tornesello Maria Lina, Maglione Maria Grazia
Maxillofacial & ENT surgery Unit, Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale", via M. Semmola, Naples, Italy.
Department of Neurosciences, Reproductive and Odontostomatological Sciences, Director and Chair, Maxillofacial Surgery unit, University of Naples "Federico II", Naples, Italy.
Infect Agent Cancer. 2020 Jun 15;15:40. doi: 10.1186/s13027-020-00306-7. eCollection 2020.
The anatomical complexity of the oropharynx and the difficulty in reaching its distal portion have always conditioned the surgical accessibility.Robotic surgery represents an excellent alternative in the treatment of cervico-facial oncological diseases.
This series comprises all patients managed for head and neck cancer by Trans Oral Robotic Surgery TORS.The staging assessment, including neck ultrasound and total body PET/CT scan, was performed in each patient according to the TNM classification.All charts were recorded with the following data: name and surname, age, gender, date of surgery intra or post-operative hemorragia, tumor site, histology, TNM stage, robot set-up time, tumor resection time, whether or not tracheotomy was performed, whether or not neck dissection was performed, insertion of a nasogastric tube or gastrostomy, time to resumption of oral feeding, surgical margins, mean length of hospital stay, adjuvant treatment and follow-up.
From February 2013 to February 2018, TORS was performed in 67 consecutive patients affected by head and neck tumours.We divided, our sample, in 3 subsites: supraglottic larynx, parapharyngeal space and oropharynx.Pathology reports confimed malignancy in 44 cases: 8 cases lymphomas, 36 cases of Squamous cell carcinoma (SCC), 5 cases of benign salivary glands tumors and 18 miscellaneous cases. Neck dissection was performed in 12 cases.Tracheotomy was perfomed in 3/67 cases for respiratory failures. A nasogastric tube was inserted at the end of the surgical procedure in 21 patients. The mean length of hospital stay was 10 days .Major complications included post-operative bleeding in 3 patients, 1 exitus for massive bleeding 20 days post-surgery and 1 respiratory failure treated with tracheotomy and monitoring in the Intensive Care Unit (ICU) for 3 days.
Robotic surgery has been considered a valid alternative to traditional open treatment in many specializations with the advantages of an endoscopic procedure, with the same oncological and functional results and with fewer complications. The advantages of this type of surgical technique have been discussed, it is mandatory to focus on the indications and contraindications.
口咽的解剖结构复杂，且难以触及其远端部分，这一直限制着手术的可及性。机器人手术是治疗头颈肿瘤疾病的一种极佳选择。
本系列研究纳入了所有接受经口机器人手术（TORS）治疗头颈癌的患者。根据TNM分类对每位患者进行分期评估，包括颈部超声和全身PET/CT扫描。所有病历均记录以下数据：姓名、年龄、性别、手术日期、术中或术后出血情况、肿瘤部位、组织学类型、TNM分期、机器人设置时间、肿瘤切除时间、是否进行气管切开术、是否进行颈部清扫术、是否插入鼻胃管或胃造瘘、恢复经口进食的时间、手术切缘、平均住院时间、辅助治疗及随访情况。
2013年2月至2018年2月，连续67例头颈肿瘤患者接受了TORS手术。我们将样本分为3个亚部位：声门上喉、咽旁间隙和口咽。病理报告证实44例为恶性肿瘤：8例淋巴瘤，36例鳞状细胞癌（SCC），5例良性唾液腺肿瘤，18例其他病例。12例患者进行了颈部清扫术。67例中有3例因呼吸衰竭进行了气管切开术。21例患者在手术结束时插入了鼻胃管。平均住院时间为10天。主要并发症包括3例术后出血，1例术后20天因大出血死亡，1例呼吸衰竭，行气管切开术并在重症监护病房（ICU）监测3天。
在许多专科领域，机器人手术被认为是传统开放治疗的有效替代方法，具有内镜手术的优势，肿瘤学和功能效果相同，并发症更少。本文讨论了这种手术技术的优点，必须关注其适应证和禁忌证。
