Effect of transcervical arterial ligation on the severity of postoperative hemorrhage after transoral robotic surgery

Abstract

Background: The value of transcervical arterial ligation during transoral robotic surgery (TORS) as a measure to decrease postoperative bleeding incidence or severity is unclear.

Methods: A retrospective single institution study was performed to identify risk factors for hemorrhage after TORS for oropharyngeal squamous cell carcinoma (SCC).

Results: Overall, 13.2% of patients (35/265) experience postoperative hemorrhage. T classification, perioperative use of anticoagulants, surgeon experience >50 cases, and tumor subsite were not predictors of postoperative hemorrhage. Of this cohort, 28% underwent prophylactic arterial ligation. The overall incidence of bleeding was not significantly decreased in patients who underwent arterial ligation (12.1% vs 13.6%; p = .84). However, arterial ligation significantly reduced the incidence of major and severe bleeding events (1.3% vs 7.8%; p = .04). Radiation before TORS was a risk factor for major and severe postoperative hemorrhage (p < .02).

Conclusion: Transcervical arterial ligation during TORS may reduce the severity of postoperative hemorrhagic events. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1510-1515, 2017.

Keywords: arterial ligation; hemorrhage; robotic surgery; transoral robotic surgery (TORS).

FIGURE 1

Classification of postoperative oropharyngeal bleeding (N = 35/265) by severity.

FIGURE 2

Timing of postoperative bleeding after transoral robotic surgery (median, day 6). Number of postoperative bleeding events by postoperative day. One outlier was excluded (>3 SD from mean).

FIGURE 3

Postoperative hemorrhage versus performance of transcervical arterial ligation.

FIGURE 4

Trend in postoperative hemorrhage (A) since implementation of transcervical arterial ligation in 2012. (B) Percentage of transoral robotic surgery cases performed with transcervical arterial ligation over time.