What can be learned about the incidence, risk factors, and management of hemorrhage following transoral robotic surgery (TORS)?
BOTTOM LINE: Although the incidence of post-TORS hemorrhage is low, and even lower for major hemorrhage requiring control measures, large tumors, perioperative anti-coagulation, and prior radiation are associated with significantly increased risk of this event.
Explore This IssueJanuary 2021
BACKGROUND: The efficacy of TORS and concurrent selective neck dissection as a primary treatment modality for intermediate-risk oropharyngeal cancer is currently under study. Postoperative hemorrhage is the most common TORS complication. However, to date, little is known about the incidence, risk factors, and management of post-TORS hemorrhage.
STUDY DESIGN: Systematic review and meta-analysis.
SETTING: Department of Otolaryngology–Head and Neck Surgery, West Virginia University Health Sciences Center, Morgantown, W. Va.
SYNOPSIS: Researchers conducted a systematic review of 13 published studies examining TORS, postoperative hemorrhage, and use of prophylactic transcervical arterial ligation (TAL). They included cohort studies of patients with aerodigestive squamous cell carcinoma treated with TORS who reported rates of postoperative hemorrhage and complications. The primary outcome was post-TORS hemorrhage; secondary outcomes were major and minor post-TORS hemorrhage. Subgroup analyses assessed the impact of previous radiation/surgery, surgeon experience, tumor size, and use of perioperative anticoagulation or antiplatelet therapy. The effect of TAL on bleeding incidence and severity was analyzed. Data analysis showed the following: The overall post-TORS hemorrhage incidence in high-volume centers is low (5.78%), and the combined incidence of major hemorrhage requiring emergent embolization, TAL, or tracheotomy to control hemorrhage is even lower (2.90%); large primary tumors, perioperative anticoagulation/antiplatelet therapy, and prior radiation were associated with increased post-TORS hemorrhage rates; and TAL did not reduce post-TORS hemorrhage incidence but may lead to fewer of these events. Study limitations included a lack of information on the intraoperative hemostasis method during the initial TORS procedure.
CITATION: Stokes W, Ramadan J, Lawson G, et al. Bleeding complications after transoral robotic surgery: a meta-analysis and systematic review. Laryngoscope Investig Otolaryngol. 2021;131:95-105.