Robot-assisted versus conventional neck dissection in head and neck cancers: A systematic review and meta-analysis

Background: Advances in technology have enabled neck dissection techniques that reduce aesthetic impact while maintaining oncological safety. This study compares perioperative outcomes between robotic neck dissection via retroauricular/modified facelift incision (RNDRM) and conventional neck dissection via anterolateral cervical incision (CND).

Methods: Studies were selected from PubMed, Embase, and Cochrane Library. Data from studies comparing RNDRM and CND were extracted and analyzed using a random-effects model.

Results: The meta-analysis included eight studies with 421 cases. The RNDRM group had a longer operative time (mean difference [MD], 69.11; 95 % confidence interval [CI] 37.92 to 100.30) and higher cosmetic satisfaction (MD, 2.03; 95 % CI, 1.48 to 2.57), along with a higher risk of marginal mandibular nerve injury (risk difference [RD], 0.08; 95 % CI 0.01 to 0.15). No significant differences were found in operative blood loss (MD, 15.35; 95 % CI - 7.39 to 38.10), days of drain placement (MD, 0.49; 95 % CI, -0.02 to 1.00), drainage volume (MD, 15.29; 95 % CI, -45.22 to 75.79), overall lymph node yield (MD, -1.09; 95 % CI, -3.18 to 1.00), positive lymph node yield (MD, -0.61; 95 % CI, -2.20 to 0.98), length of hospital stay (MD, 1.07; 95 % CI -0.06 to 2.20), or regional recurrence (RD, 0.00; 95 % CI -0.05 to 0.05), with similar rates of other complications.

Conclusion: RNDRM offers better cosmetic outcomes but requires longer operative time and has a higher risk of marginal mandibular nerve injury than CND. It may be an alternative for selected patients, with surgery choice needing discussion between patient and surgeon.