Transoral robotic salvage oropharyngectomy with submental artery island flap reconstruction

Holcomb, Andrew J.; Richmon, Jeremy D.

doi:10.1002/hed.26543

Cited by 7 publications

(10 citation statements)

References 24 publications

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“…Of these, 51 articles were reviewed in full following screening and removal of duplicates. A total of 26 final studies met inclusion based on appropriateness of patient population, intervention performed, and outcome of interest adequately specified 15–40 . One study detailing reconstructive strategies of TORS defects was excluded due to lack of description regarding specific reconstructive modalities used in the patient cohort described 11 .…”

Section: Resultsmentioning

confidence: 99%

Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

et al. 2022

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We performed a systematic review to characterize reconstructive modalities and postoperative surgical outcomes following TORS resection. A search of the PubMed, SCOPUS, and EMBASE databases was conducted to identify studies describing patients undergoing reconstruction of TORS defects. Twenty‐six studies met inclusion criteria, consisting of 260 patients who underwent TORS resection followed by reconstruction. Twenty‐one studies reported tumor classification information, with TORS performed for 44 (23.0%) T1, 86 (45.0%) T2, 33 (17.3%) T3, and 28 (14.7%) T4 tumors. Eighteen distinct reconstructive modalities were described in the studies identified, including nine unique free flap types. The most commonly performed reconstruction was the radial forearm free flap (RFFF), accounting for 121/260 (46.5%) of reconstructions performed. Reported surgical complications included 5 pharyngocutaneous fistulae, 13 hemorrhagic complications, 24 infectious complications, and 5 free flap failures. Our findings demonstrate favorable surgical outcomes but minimal quantitative functional data to compare reconstructive options following TORS.

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Section: Resultsmentioning

confidence: 99%

Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

et al. 2022

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“…However, few local flaps have been used to cover the lateral oropharynx. Regional flaps that have been used for reconstruction of the lateral oropharynx include the temporalis myofascial flap, the submental island flap, and the supraclavicular flap 9–11 . Our clinical series is the first to study the use of the NSF for lateral oropharyngeal reconstruction with exposure of the ICA, clips in the parapharyngeal space, or exposed mandibular bone.…”

Section: Discussionmentioning

confidence: 99%

“…Local rotational flaps include the uvulopalatal flap, the superior constrictor advancement flap, and the prevertebral muscle flap 4–6 . Locoregional pedicled flaps described include the palatal island flap, the facial artery musculomucosal (FAMM) flap, the temporalis muscle flap, the submental island flap, and the supraclavicular island flap 7–11 . Finally, microvascular free flap reconstruction has been performed in case series, the largest of which has 20 patients 2,12,13 …”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] Locoregional pedicled flaps described include the palatal island flap, the facial artery musculomucosal (FAMM) flap, the temporalis muscle flap, the submental island flap, and the supraclavicular island flap. [7][8][9][10][11] Finally, microvascular free flap reconstruction has been performed in case series, the largest of which has 20 patients. 2,12,13 Use of the nasoseptal flap (NSF) was first described by Pinheiro-Neto in 2017 for soft palate reconstruction after robotic-assisted radical tonsillectomy.…”

Section: Introductionmentioning

confidence: 99%

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The Nasoseptal Flap for Reconstruction of Lateral Oropharyngectomy Defects: A Clinical Series

et al. 2021

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Objectives/Hypothesis: To study use of the nasoseptal flap (NSF) to reconstruct lateral transoral robotic surgery (TORS) oropharyngectomy defects.Study Design: Retrospective case series. Methods: A clinical series of six patients undergoing NSF reconstruction of lateral TORS oropharyngectomy defects was retrospectively studied. All patients underwent TORS for the treatment of intermediate-risk human papillomavirus (HPV)positive oropharyngeal squamous cell carcinoma of the lateral pharyngeal wall between January and June 2017. All patients underwent NSF reconstruction of lateral TORS defects with retrospective analysis of outcomes and complications.Results: Six patients underwent NSF reconstruction of lateral TORS defects. Operative times decreased from 180 minutes to 90 minutes over the study period. There were two cases of partial flap dehiscence and partial necrosis. There were no major donor site complications. All patients had temporary nasal obstruction and crusting. Two experienced temporary aural fullness. In all patients, the lateral wall was mucosalized in 1-3 weeks. Cephalometric analysis of preoperative imaging revealed that patients with high-arched palates (>3 cm) and defect lengths that are longer than NSF flap lengths are poor candidates for this technique.Conclusions: This NSF is a vascularized, locoregional rotational flap that can reconstruct lateral TORS defects in salvages cases or those where the parapharyngeal carotid or mandibular bone are exposed. Postoperative morbidity is limited to temporary nasal dyspnea, aural fullness, and crusting. Preoperative imaging can determine which patient will have successful defect coverage.

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“…Other factors that contribute to improved overall survival include longer disease free interval and lower disease burden at time of recurrence ( 3 , 57 , 58 ). Treatment of recurrent disease with surgical salvage with or without adjuvant therapy when feasible, is associated with significant improvement in survival after both locoregional and distant recurrence ( 3 , 4 , 7 , 57 , 59 , 60 ). The retrospective nature of salvage surgery studies should be recognized, where patients with localized disease burden and higher performance status are more likely to be selected for surgical salvage.…”

Section: Considerations For Management Of Recurrent Diseasementioning

confidence: 99%

Current perspectives on recurrent HPV-mediated oropharyngeal cancer

2022

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In the recent years, the prevalence of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) has increased significantly. Currently, nearly 80-90% of all oropharynx tumors are HPV-positive. In addition, it is now recognized that HPV-positive tumor status is associated with good prognosis and improved response to chemoradiation. However, within this setting, there are still patients with HPV-positive OPSCC who will experience recurrence. With the increasing incidence of HPV-mediated OPSCC, recurrent HPV disease is also becoming more prevalent and there is an increasing need to understand the unique presentation and treatment of recurrent HPV-mediated disease. In this review, we will discuss epidemiology of recurrent HPV-positive OPSCC, role of surgical salvage, re-irradiation, and the role of upcoming novel treatments and immunotherapy. Historically, recurrent oropharyngeal disease has been associated with poor prognosis and high morbidity. However, recent advances have transformed the landscape for salvage treatment of HPV-mediated OPSCC. Liquid biomarkers offer potential for early detection of recurrence, robotic techniques may reduce morbidity of surgical salvage, improvements in re-irradiation approaches reduce toxicities, and novel immune based therapies on the horizon are offering promising results. These advances combined with the improved prognosis of HPV-positive disease offer to transform our approach to recurrent disease of the oropharynx.

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Transoral robotic salvage oropharyngectomy with submental artery island flap reconstruction

Cited by 7 publications

References 24 publications

Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

Reconstruction following transoral robotic surgery for head and neck cancer: Systematic review

The Nasoseptal Flap for Reconstruction of Lateral Oropharyngectomy Defects: A Clinical Series

Current perspectives on recurrent HPV-mediated oropharyngeal cancer

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