Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Edmonton, AB, Canada.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
J Robot Surg. 2023 Aug;17(4):1287-1297. doi: 10.1007/s11701-023-01572-4. Epub 2023 Mar 25.
Transoral robotic surgery (TORS) approach for the treatment of oropharyngeal cancer allows for reduced patient morbidity, amongst other advantages over the traditional lip-splitting mandibulotomy method. Free-flap reconstruction is commonly utilized in head and neck cancer surgeries; however, safety and outcomes of this technique in TORS procedures have not been well studied. The objective of this study was to perform a systematic review to evaluate the efficacy and safety of TORS with free-flap reconstruction (TORS-FFR) for oropharyngeal cancer. A systematic search of Scopus, EMBASE, CINAHL and PubMed databases was completed. Following PRISMA guidelines, case series/reports, retrospective and prospective cohort studies were included. Primary outcomes measured were deaths and complication rates associated with TORS-FFR for oropharyngeal cancers. Secondary outcomes included functional swallowing and airway outcomes, operative time and length of hospital stay. Twenty-one studies met the inclusion criteria comprising a total of 132 patients. The mean patient age was 58.4 years. The most frequent complication was infection (8.9%) followed by flap wound dehiscence (4.2%). The average total operative time was 710 min (n = 48), while average length of hospital stay was 13.5 days (n = 48). Reconstructions were most commonly fashioned from radial forearm free flaps (RFFF), with anterolateral thigh flaps (ALT) representing the second most common free-flap subtype. TORS-FFR procedures for oropharyngeal cancer are safe, with low serious complication rates. This surgical approach may be associated with decreased length of hospital stay; however, further studies are required to better characterize post-operative outcomes.Level of evidence 1a.
经口机器人手术（TORS）治疗口咽癌具有减少患者发病率等优势，优于传统的唇裂下颌骨切开术。游离皮瓣重建术常用于头颈部癌症手术；然而，TORS 手术中该技术的安全性和结果尚未得到充分研究。本研究的目的是进行系统评价，以评估 TORS 联合游离皮瓣重建（TORS-FFR）治疗口咽癌的疗效和安全性。对 Scopus、EMBASE、CINAHL 和 PubMed 数据库进行了系统搜索。根据 PRISMA 指南，纳入了病例系列/报告、回顾性和前瞻性队列研究。主要结局测量与 TORS-FFR 治疗口咽癌相关的死亡和并发症发生率。次要结局包括功能吞咽和气道结局、手术时间和住院时间。21 项研究符合纳入标准，共纳入 132 例患者。患者平均年龄为 58.4 岁。最常见的并发症是感染（8.9%），其次是皮瓣伤口裂开（4.2%）。平均总手术时间为 710 分钟（n=48），平均住院时间为 13.5 天（n=48）。重建最常采用游离前臂皮瓣（RFFF），股前外侧皮瓣（ALT）是第二常见的游离皮瓣类型。TORS-FFR 治疗口咽癌是安全的，严重并发症发生率低。这种手术方法可能与住院时间缩短有关；然而，需要进一步的研究来更好地描述术后结局。证据水平 1a。
