title: Transoral robotic surgery with radial forearm free flap reconstruction: case control analysis.
abstract: 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.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada. vbiron@ualberta.ca.|Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada. vbiron@ualberta.ca.
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Biron
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.|Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: O'Connell
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.
authors.forename: Brittany
authors.initials: B
authors.lastname: Barber
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Clark
authors.affiliation: Faculty of Medicine and Dentistry, Undergraduate Medical Education, Edmonton, AB, Canada.
authors.forename: Colin
authors.initials: C
authors.lastname: Andrews
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.
authors.forename: Caroline C
authors.initials: CC
authors.lastname: Jeffery
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.
authors.forename: David W J
authors.initials: DW
authors.lastname: Côté
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.|Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Harris
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Alberta, 8440-112 st, 1E4 Walter Mackenzie Centre, Edmonton, AB, T6G 2B7, Canada.|Alberta Head & Neck Centre for Oncology and Reconstruction, Edmonton, AB, Canada.
authors.forename: Hadi
authors.initials: H
authors.lastname: Seikaly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D005542:Forearm; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D063168:Mandibular Osteotomy; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome
keywords: Human papillomavirus; Mandibulotomy; Oropharyngeal cancer; Radial forearm free flap; Transoral robotic surgery