Transoral robotic retropharyngeal node dissection in oropharyngeal squamous cell carcinoma: Patterns of metastasis and functional outcomes

Troob, Scott H.; Givi, Babak; Hodgson, Macgregor; Mowery, Alia; Gross, Neil D.; Andersen, Peter E.; Clayburgh, Daniel

doi:10.1002/hed.24786

Cited by 23 publications

(27 citation statements)

References 17 publications

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“…TORS is a safe and mini‐invasive approach to a critical anatomic area such as the retropharynx. Magnification, 3D vision, and articulated arms provided by the robotic arms allow for a comfortable dissection in a narrow space even in close proximity to critical structures such as the parapharyngeal internal carotid artery and sympathetic chain …”

Section: Discussionmentioning

confidence: 99%

“…In this particular case, as the patient has already had a total laryngectomy, both airway protection and surgical exposure did not represent an issue. Generally speaking, other experiences in literature report no necessity of temporary tracheotomy when dealing with retropharyngeal node dissection through a TORS approach . The daVinci Si system was equipped with a 0°degree camera, a 5 mm Maryland forceps, and a 5 mm monopolar cautery that were placed in the center, left, and right side of the surgical field, respectively.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…Transoral robotic approach (TORS) has become an integral part of contemporary head and neck cancer surgery . Early experiences of a few research groups regarding TORS in the management of RPLNs have been reported in recent literature . In this study we describe a step‐by‐step TORS for the retropharyngeal node dissection (RND) in a case of recurrent head and neck carcinoma.…”

Section: Introductionmentioning

confidence: 99%

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Transoral robotic retropharyngeal lymph node dissection in a recurrent head and neck carcinoma

et al. 2019

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Background A step‐by‐step demonstration of the transoral robotic surgical approach (TORS) used in retropharyngeal node dissection (RND) in a recurrent head and neck carcinoma. Methods Clinical human study of TORS RND via en bloc resection using a daVinci Si system (Intuitive Surgical, Inc., Sunnyvale, California). Results A daVinci Si system provided sufficient access, reach, and visualization to perform TORS‐RND. Access and exposure were achieved with a Feyh‐Kastenbauer (FK) retractor (Gyrus Medical Inc., Tuttlingen, Germany). Two surgical instruments and one 3D camera arm can be deployed with minimal collision or restriction of arm movement. Conclusions Routine transcervical, transparotid, and transmandibular RNDs can provoke potentially serious surgical morbidities and complications. This study demonstrates the technical feasibility of TORS RND in a 68‐year‐old man.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Proceduresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transoral robotic retropharyngeal lymph node dissection in a recurrent head and neck carcinoma

et al. 2019

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“…31 Historically, RPLN metastases have been associated with decreased overall survival. Reports in the literature have shown metastatic rates ranging from 13% to 36% and more commonly with tonsil primaries.…”

Section: Discussionmentioning

confidence: 99%

“…Reports in the literature have shown metastatic rates ranging from 13% to 36% and more commonly with tonsil primaries. 31 Lymphoscintigraphy would be a method of determining which patients with OPSCC have retropharyngeal drainage patterns thus either requiring a RPLN dissection or irradiation for proper management of this lymphatic basin. [31][32][33] A study by Troob et al reported their incidence of metastatic RPLNs in T1-T3 OPSCC patients to be 20% (n = 6).…”

Section: Discussionmentioning

confidence: 99%

Lymphatic mapping with SPECT‐CT for evaluation of contralateral drainage in lateralized oropharyngeal cancers using an awake injection technique

et al. 2019

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Background: Risk of contralateral nodal metastases in oropharyngeal squamous cell carcinoma (OPSCC) is currently based on clinical risk factors. We propose lymphatic mapping with single photon emission computed tomography (SPECT-CT) for tumor-specific delineation of lymphatic drainage to guide treatment.Methods: Retrospective review of lymphatic drainage patterns in cT1-2 OPSCC and contralateral cN0 neck with a nonoperative, awake injection of 99 m-Tc sulfur colloid and SPECT-CT. Results: Ten patients were reviewed. Primary sites included tonsil (n = 8, 80%) and tongue base (n = 2, 20%). All patients tolerated awake injections with no complications. Nine patients (90%) demonstrated satisfactory migration of radiotracer to neck node(s) with seven (78%) to the ipsilateral lateral neck, one (11%) to the ipsilateral lateral neck and retropharynx, and one (11%) to bilateral lateral neck nodes.Conclusions: Characterization of lymphatic drainage in OPSCC is feasible using a nonoperative injection technique and SPECT-CT. Drainage to the contralateral neck is rare, warranting further study to tailor treatment appropriately. K E Y W O R D Sawake injection, lymphoscintigraphy, neck dissection, oropharyngeal squamous cell carcinoma, sentinel lymph node biopsy, SPECT-CT, transoral robotic surgery

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Prevalence and prognostic impact of retropharyngeal lymph nodes metastases in oropharyngeal squamous cell carcinoma: Meta‐analysis of published literature

et al. 2022

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Background: This systematic review and meta-analysis aims to estimate the prevalence and prognostic impact of retropharyngeal lymph node metastases (RLNMs) in oropharyngeal squamous cell carcinoma (OPSCC). Methods: This meta-analysis was conducted according to PRISMA guidelines.Inclusion criteria: studies with more than 20 patients reporting the prevalence or prognostic impact of RLNMs in OPSCC. Whenever available, data on HPV status and subsites were extracted.Results: Twenty-two articles were included. The overall prevalence of RLNMs in OPSCC was 13%, with no significant differences depending on HPV status.The highest prevalence was observed for posterior pharyngeal wall SCC (24%), followed by soft palate (17%), palatine tonsil (15%), and base of tongue (8%). RLNMs were associated with a significantly higher risk of death (HR:2.54; IC95%1.89-3.41) and progression (HR:2.44;IC95%1.80-3.30). Conclusions: The prevalence of RLNMs in OPSCC was 13%, being higher in tumors of the posterior pharyngeal wall. RLNMs were associated with unfavorable outcomes.

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Transoral robotic retropharyngeal node dissection in oropharyngeal squamous cell carcinoma: Patterns of metastasis and functional outcomes

Abstract: RPLND is technically feasible by a purely transoral robotic approach. Its performance is not associated with worse swallowing outcomes or rates of complication. In select patients, RPLND may provide valuable staging information and guide the selection of adjuvant therapy.

Cited by 23 publications

References 17 publications

Transoral robotic retropharyngeal lymph node dissection in a recurrent head and neck carcinoma

Transoral robotic retropharyngeal lymph node dissection in a recurrent head and neck carcinoma

Lymphatic mapping with SPECT‐CT for evaluation of contralateral drainage in lateralized oropharyngeal cancers using an awake injection technique

Prevalence and prognostic impact of retropharyngeal lymph nodes metastases in oropharyngeal squamous cell carcinoma: Meta‐analysis of published literature

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