Alhashim Mohammed Abdulrahman, Alrahim Ahmed Abdulrahman, Aljaafari Abdullah Omar, Maawadh Lojain M, Alfadley Abdulaziz Fadel, Alabdulmhsin Marwah Foud, Alqutub Abdulsalam
ENT Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia.
Eur Arch Otorhinolaryngol. 2025 Sep 18. doi: 10.1007/s00405-025-09676-3.
Less than 1% of head and neck tumors are in the parapharyngeal space (PPS). With complex anatomy, conventional surgery is challenging. Endoscopy-assisted transoral approach (EATA) minimizes trauma and scarring; however, criticism regarding infeasibility with large tumors led to the introduction of transoral robotic surgery (TORS), which gives a 3D view of the field, reduces operative time, and is effective for larger tumors but faces technical and operational issues. This review compares the outcomes and complications of TORS and EATA.
We searched four databases for relevant articles up to January 2025. Two independent reviewers extracted data from the selected studies, including baseline information, operative time, blood loss, and hospitalization time.
We reviewed 32 studies, of which 27 provided sufficient data for analysis. These studies involved 348 patients treated for PPS tumors using either EATA or TORS. Operative times were similar for both methods, with EATA averaging 92.31 min and TORS averaging 93.93 min (p = 0.9385). However, compared to EATA, TORS was associated with reduced blood loss (16.98 ml, 95% CI: 9.38-24.59; p < 0.0001) and a shorter hospitalization duration (3.39 days, 95% CI: 2.51-4.27; p = 0.0278). Common complications associated with endoscopy included Horner's syndrome and wound dehiscence, whereas TORS rarely reported severe complications. No fatalities were documented for either method.
TORS is not inferior to EATA regarding operative time, with reduced blood loss and shorter hospital stays..
头颈部肿瘤中不到1%位于咽旁间隙（PPS）。由于解剖结构复杂，传统手术具有挑战性。内镜辅助经口入路（EATA）可将创伤和瘢痕最小化；然而，对于大型肿瘤不可行的批评导致了经口机器人手术（TORS）的引入，该手术可提供手术视野的三维视图，减少手术时间，对较大肿瘤有效，但面临技术和操作问题。本综述比较了TORS和EATA的疗效及并发症。
我们检索了四个数据库，以获取截至2025年1月的相关文章。两名独立 reviewers 从选定的研究中提取数据，包括基线信息、手术时间、失血量和住院时间。
我们回顾了32项研究，其中27项提供了足够的数据分析。这些研究涉及348例使用EATA或TORS治疗PPS肿瘤的患者。两种方法的手术时间相似，EATA平均为92.31分钟，TORS平均为93.93分钟（p = 0.9385）。然而，与EATA相比，TORS的失血量减少（16.98 ml，95% CI：9.38 - 24.59；p < 0.0001），住院时间缩短（3.39天，95% CI：2.51 - 4.27；p = 0.0278）。与内镜检查相关的常见并发症包括霍纳综合征和伤口裂开，而TORS很少报告严重并发症。两种方法均未记录到死亡病例。
TORS在手术时间方面不劣于EATA，且失血量减少，住院时间缩短。
