Revisiting vascular contraindications for transoral robotic surgery for oropharyngeal cancer

Philippe Gorphe; Anne Auperin; Jean-François Honart; Jean Ton Van; Sophie El Bedoui; François Bidault; Stéphane Temam; Frédéric Kolb; Quentin Qassemyar

doi:10.1002/lio2.152

Revisiting vascular contraindications for transoral robotic surgery for oropharyngeal cancer

Laryngoscope Investig Otolaryngol. 2018 Mar 25;3(2):121-126. doi: 10.1002/lio2.152. eCollection 2018 Apr.

Authors

Philippe Gorphe¹, Anne Auperin², Jean-François Honart³, Jean Ton Van^{1

2

3

4}, Sophie El Bedoui^{1

2

3

4}, François Bidault⁴, Stéphane Temam¹, Frédéric Kolb³, Quentin Qassemyar³

Affiliations

¹ Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.
² Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.
³ Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.
⁴ Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.

Abstract

Objective: We analyzed the outcomes for patients with a retropharyngeal internal carotid artery (ICA) who underwent a transoral robotic surgery (TORS) procedure involving a cervical-transoral robotic oropharyngectomy course with free flap reconstruction.

Methods: Patients were included in the prospective multicentric trial NCT02517125. These patients were scheduled to undergo surgery for an oropharyngeal localization. By pre-operative CT scan and MRI it was determined that they had a retropharyngeal internal carotid artery.

Results: Three patients had a retropharyngeal ICA: a patient with a 35 mm synovial sarcoma of the tonsillar fossa, a patient with a T2N2b squamous-cell carcinoma (SCC) of the glossotonsillar sulcus, and a patient with a T3N0 SCC of the tonsillar fossa in a previously irradiated field. These patients encountered neither preoperative nor postoperative complications.

Conclusions: In our experience, TORS for oropharyngeal cancers appears to be feasible in patients with a retropharyngeal ICA, provided that the procedure has been adapted for complex situations.

Level of evidence: 4.

Keywords: TORS; cervical‐transoral robotic oropharyngectomy; fasciocutaneous free flap; retropharyngeal internal carotid artery; transoral robotic surgery.