title: Timing of neck dissection in patients undergoing transoral robotic surgery for head and neck cancer.
abstract: BACKGROUND
  Oncologic transoral robotic surgery (TORS) requires in most cases the concurrent or staged surgical treatment of the regional lymph nodes in the neck as well. The purpose of this study was to determine whether the timing of the regional lymphadenectomy (neck dissection) has an impact on the surgical outcomes and on the complication rates.
  
  
  METHODS
  Single-institution, prospective case series with internal control group. Twenty-one patients underwent TORS and appropriate neck dissection concurrently (control group), while 20 patients underwent neck dissection in a timely staged fashion, 8.4 days (median; range, 3-28 days) following their TORS procedure (experimental group). Outcome measures included nodal yield, intraoperative pharyngocervical fistula formation, postoperative fistula formation, postoperative bleeding from the primary and from the neck dissection site, haematoma, seroma, and infection.
  
  
  RESULTS
  Nodal yield values, as the oncologic quality indicator of a neck dissection, were comparable in the experimental and in the control group. Complication rates did not differ between the groups: intraoperative and postoperative fistula formation, postoperative bleeding, haematoma and seroma rates were similarly low in the two groups. There was no infection in either group.
  
  
  CONCLUSIONS
  In the present cohort of 41 TORS-patients, the timing of neck dissection did not make a significant difference in the outcomes. We suggest therefore that aspiring and established TORS-teams do not restrict their appropriate indications due to robotic slot and theatre time constraints, but perform each indicated TORS-case as soon as possible within their given systems, even if the neck dissections cannot be done on the same day.
authors.affiliation: Department of Otorhinolaryngology, Head & Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Head and Neck Cancer Centre of the University Cancer Centre Hamburg (UCCH), Martinistr. 52, D-20246 Hamburg, Germany. Electronic address: n.moeckelmann@uke.de.
authors.forename: N
authors.initials: N
authors.lastname: Möckelmann
authors.affiliation: Department of Otorhinolaryngology, Head & Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Head and Neck Cancer Centre of the University Cancer Centre Hamburg (UCCH), Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: C-J
authors.initials: CJ
authors.lastname: Busch
authors.affiliation: Department of Otorhinolaryngology, Head & Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Head and Neck Cancer Centre of the University Cancer Centre Hamburg (UCCH), Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Münscher
authors.affiliation: Department of Otorhinolaryngology, Head & Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Head and Neck Cancer Centre of the University Cancer Centre Hamburg (UCCH), Martinistr. 52, D-20246 Hamburg, Germany. Electronic address: r.knecht@uke.de.
authors.forename: R
authors.initials: R
authors.lastname: Knecht
authors.affiliation: Department of Otorhinolaryngology, Head & Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Head and Neck Cancer Centre of the University Cancer Centre Hamburg (UCCH), Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: B B
authors.initials: BB
authors.lastname: Lörincz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D017577:Cutaneous Fistula / Q000209:etiology; D005260:Female; D005402:Fistula / Q000209:etiology; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007902:Length of Stay; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009055:Mouth; D009333:Neck; D037981:Neck Dissection / Q000009:adverse effects* / Q000379:methods; D010608:Pharyngeal Diseases / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D049291:Seroma / Q000209:etiology; D013997:Time Factors
keywords: Head and neck squamous cell carcinoma (HNSCC); Neck dissection; Nodal yield; Pharyngeal fistula; Transoral robotic surgery (TORS)