What´s new in PubMed this week
Kim GJ, Shin HI, Bang J, Sun DI, Kim SY. Assessment of oncologic and cosmetic outcomes of robotic elective neck dissection in early-stage tongue cancer. Eur J Surg Oncol. 2024 Jul 14;50(10):108548. doi: 10.1016/j.ejso.2024.108548. Epub ahead of print. PMID: 39047329.
Outcomes support retroauricular neck dissection based on cosmetic satisfaction. When neck dissection is associated with a transoral approach for the primary tumor, the only visible scar is that of the neck dissection. Therefore it appears natural to try to hide the scar through a retroauricular approach, particularly for an elective procedure.
The question here is the need for an elective neck dissection. Occult lymph node metastasis were 2 out of 32 cases in the robotic retroauricular group (6,3%) and 2 out of 46 cases in the open surgery group (4,3%). Many of us would consider observation for T1 and sentinel node biopsy for T2 tongue cancer as a general rule.
Haugen T, Prichardo P, Hellums R, Anil J, Rajasekaran K. Transoral Robotic Surgery-Assisted Removal of Upper Aerodigestive Tract Foreign Bodies with Intraoperative Localization. Ann Otol Rhinol Laryngol. 2024 Jul 23:34894241264942. doi: 10.1177/00034894241264942. Epub ahead of print. PMID: 39044380.
An interesting new indication for TORS.
Zhi Y, Zhang Y, Zhang B. Transoral robotic surgery in the diagnosis and treatment of primary unknown head and neck squamous cell carcinoma: A preliminary single centre experience. Int J Med Robot. 2024 Jun;20(3):e2652. doi: 10.1002/rcs.2652. PMID: 39031752.
Another paper on TORS for the unknown primary. A series of 11 cases with a positive finding rate of 72,7%. Is there still any institution not performing lingual tonsil excisional biopsy for the unknown primary? Where this is the case, patients are being overtly over-treated.
Snyder V, Kraft DO, Creamer A, Spector ME, Sridharan SS. A Scoping Review of Pain Management After Transoral Robotic Surgery. Otolaryngol Head Neck Surg. 2024 Jun 21. doi: 10.1002/ohn.871. Epub ahead of print. PMID: 39031715.
Yes, this is a pending subject.
Every surgeon has diverse experiences. Some cases with extensive TORS resections show limited pain, probably due to denervation, while others with limited procedures experience intense and prolonged pain. This is particularly frequent in salvage surgery for previously irradiated patients. We all have cases of delayed painful healing.
Although every institution has its management protocols for this, more high-evidence information would probably be desirable.
J Granell. July 28, 2024.