背景:大口咽肿瘤的切除传统上涉及唇裂下颌骨切开术,以获得足够的切缘可视化和手术缺损的游离皮瓣重建。经口机器人手术(TORS)已经成为一种可以切除大型复杂口咽肿瘤的技术,避免嘴唇分裂的方法。这项研究的目的是比较唇裂下颌骨切开术与TORS治疗晚期口咽癌的方法。
方法:前瞻性收集了18例晚期口咽鳞状细胞癌(OPSCC)患者的数据,这些患者接受了TORS和radial前臂游离皮瓣重建(RFFF),并与39例接受唇劈裂下骨切开术和RFFF的患者进行了比较。患者进行阶段匹配,P16阳性,吸烟,年龄和性别。住院时间(LOHS)气管造口术拔除时间,手术时间,手术边缘状态,比较两组患者术后并发症发生情况。
结果:接受RFFF的TORS患者的平均LOHS明显降低,与通过唇裂下颌骨切开术和RFFF治疗的患者相比(14.4vs19.7天,p=0.03)。两组之间在手术时间上没有显着差异,气管造口术拔管时间,切缘阳性和术后并发症。
结论:TORS采用桡骨前臂游离皮瓣重建是一种安全的,有效且节省成本的替代唇裂下颌骨切开术治疗晚期OPSCC。
BACKGROUND: The resection of large oropharyngeal tumors traditionally involves a lip-splitting
mandibulotomy for adequate margin visualization and free flap reconstruction of the surgical defect. Transoral robotic surgery (TORS) has emerged as a technique that can resect large and complex oropharyngeal tumors, avoiding a lip-splitting approach. The aim of this study is to compare the lip-splitting
mandibulotomy approach versus TORS for the management of advanced stage oropharyngeal carcinomas.
METHODS: Prospectively collected data from 18 patients with advanced stage oropharyngeal squamous cell carcinoma (OPSCC) who received TORS with radial forearm free flap reconstruction (RFFF) was compared to a matched cohort of 39 patients who received a lip-splitting
mandibulotomy and RFFF. Patients were matched for stage, p16 positivity, smoking, age and gender. Length of hospital stay (LOHS), tracheostomy decanulation time, operative time, surgical margin status, and post-operative complications were compared between groups.
RESULTS: Patients who received TORS with RFFF had a significantly lower mean LOHS, compared to patients who were treated by lip-splitting
mandibulotomy and RFFF (14.4 vs 19.7 days, p = 0.03). No significant differences were seen between groups in terms of operative time, tracheostomy decannulation time, margin positivity and post-operative complications.
CONCLUSIONS: TORS with radial forearm free flap reconstruction is a safe, effective and cost-saving alternative to the lip-splitting
mandibulotomy approach for the treatment of advanced stage OPSCC.