Retropharyngeal lymphadenectomy with transoral robotic surgery for papillary thyroid cancer

Abstract

Retropharyngeal metastasis of papillary thyroid carcinoma is a rare but well recognized phenomenon. Traditional open surgical approaches to nodal metastasis located in the retropharyngeal space are particularly morbid considering the relatively indolent nature of some thyroid cancers. Minimally invasive surgical approaches offer a useful alternative that is both low in morbidity and high in levels of patient acceptance. To assess feasibility and safety, we report a case series of robotic lymphadenectomy in two patients with thyroid cancer metastatic to the retropharyngeal space. Two patients, ages 66 and 73, with unilateral recurrent papillary carcinoma of the retropharyngeal lymph nodes had previously undergone thyroidectomy, neck dissection, and radioactive iodine ablation prior to retropharyngeal resection. Retropharyngeal lymphadenectomy via transoral robotic surgery was performed for both patients: for the first, the oropharyngeal wound was left to heal by secondary intention, while for the other patient, simple pharyngeal flap closure was performed. Retropharyngeal lymph node dissections were successfully carried out using a transoral robotic retropharyngotomy with the da Vinci surgical robotic system. Both patients tolerated the procedure well. One patient did developed temporary dysphagia which resolved with conservative measures, not requiring a feeding tube. We report the first two cases of transoral robot-assisted resection of thyroid cancer metastatic to the retropharyngeal lymph nodes. The technique is feasible, minimally invasive, and appears to be as safe as conventional surgical methods in achieving the goals of management of regionally metastatic disease.

Transoral robotic retropharyngeal node dissection

“…6,[12][13][14] There exists only a single case report with 2 patients treated via TORS RPLN dissection for metastatic thyroid cancer. 18 Both patients in that study had an uncomplicated postoperative course. In our study, the 3 patients with thyroid cancer undergoing TORS RPLN had a similar short recovery with early resumption of oral intake and short hospital stay.…”

“…Transoral approaches to isolated papillary and medullary thyroid metastases to RPLNs have been reported . There exists only a single case report with 2 patients treated via TORS RPLN dissection for metastatic thyroid cancer . Both patients in that study had an uncomplicated postoperative course.…”

Current indications and patient selection for transoral robotic surgery in head and neck cancer: a brief review

“…Inferiorly, this space is continuous with the posterior mediastinum [ 27 ]. Classically, nodal metastasis in this area comes from advanced T-stage head and neck cancers and thyroid cancer [ 28 , 29 ]. Thus, the presence of metastatic spread in this area is recognized as an important prognostic factor that may affect overall survival [ 29 ].…”

Robotics in neurosurgery

“…A limited number of studies report about the feasibility of TORS for RPLND, either for metastatic nodes associated with an oropharyngeal primary or thyroid cancer. [28][29][30][31] However, the next generation of robotic systems with a flexible single arm may facilitate the resection of the primary tumour and RPLND. 32…”