Ramchandani Jai Parkash, Brunet Aina, Skalidi Nikoleta, Faulkner Jack, Rovira Aleix, Simo Ricard, Jeannon Jean-Pierre, Arora Asit
King's College London, London, England.
Department of Otorhinolaryngology and Head and Neck Surgery, Guy's and St Thomas NHS Foundation Trust, London, England.
OTO Open. 2022 Oct 11;6(4):2473974X221131513. doi: 10.1177/2473974X221131513. eCollection 2022 Oct-Dec.
This review assesses the effect on intra- and postoperative patient outcomes of the timing of neck dissection in relation to transoral surgery. Outcome measures include postoperative bleeding, intra- and postoperative fistula formation, and disease-specific and overall survival.
A search was conducted across the MEDLINE, Embase, US National Library of Medicine, and Cochrane databases with search terms in July 2021.
Articles that conformed with specified inclusion criteria were included. Included articles were scanned for bias with the ROBINS-I tool.
Nineteen articles were selected for qualitative analysis, including 546 patients who had neck dissection in conjunction with transoral robotic surgery/transoral laser microsurgery (TORS/TLM). Seventy-one (18%) patients had neck dissection prior to TORS/TLM, 39 (10%) had neck dissection performed after TORS/TLM, and 281 (72%) had concurrent procedures. In patients with neck dissection before TORS/TLM, 3% experienced major postoperative bleeding, and fistula rates were 0%. In the cohort with neck dissection after TORS/TLM, 3% experienced minor postoperative hemorrhage, and 8% had intraoperative fistulae. In the concurrent cohort of patients, 1% had major postoperative bleeds and 0.3% had minor bleeds, while 4% developed intraoperative fistulas and 0.3% developed postoperative fistulas.
Current evidence indicated that there appears to be no correlation between timing of neck dissection and complications. This systematic review found insufficient data to comment on whether the timing of neck dissection in relation to TORS/TLM affects the outcomes of patients.
本综述评估颈部清扫术与经口手术的时间安排对患者术中和术后结局的影响。结局指标包括术后出血、术中和术后瘘管形成以及疾病特异性生存率和总生存率。
2021年7月，使用检索词在MEDLINE、Embase、美国国立医学图书馆和Cochrane数据库中进行了检索。
纳入符合特定纳入标准的文章。使用ROBINS-I工具对纳入的文章进行偏倚筛查。
选择了19篇文章进行定性分析，包括546例接受颈部清扫术联合经口机器人手术/经口激光显微手术（TORS/TLM）的患者。71例（18%）患者在TORS/TLM之前接受了颈部清扫术，39例（10%）在TORS/TLM之后接受了颈部清扫术，281例（72%）进行了同期手术。在TORS/TLM之前接受颈部清扫术的患者中，3%发生了严重术后出血，瘘管发生率为0%。在TORS/TLM之后接受颈部清扫术的队列中，3%发生了轻微术后出血，8%发生了术中瘘管。在同期手术的队列中，1%发生了严重术后出血，0.3%发生了轻微出血，而4%发生了术中瘘管，0.3%发生了术后瘘管。
目前的证据表明，颈部清扫术的时间安排与并发症之间似乎没有相关性。本系统综述发现，没有足够的数据来评论颈部清扫术与TORS/TLM的时间安排是否会影响患者的结局。
