# Efficacy of Vascular Ligation for the Prevention of Intra- and Postoperative Bleeding in Transoral Robotic Surgery for Oropharyngeal Cancer

## TL;DR

This study examines how vascular ligation helps prevent bleeding during robotic surgery for throat cancer, finding it effective when used with proper patient selection.

## Contribution

The study evaluates vascular ligation and neck dissection methods in transoral robotic surgery for oropharyngeal cancer in Japan.

## Key findings

- Significant differences in operative duration and blood loss were found between different neck dissection approaches.
- Postoperative bleeding occurred in one case in each group, indicating some risk remains.
- Vascular ligation combined with appropriate case selection can lead to safe, minimally invasive treatments.

## Abstract

Transoral robotic surgery is a minimally invasive procedure, but the target patient, oropharyngeal cancer, has often cervical lymph node metastases and also requires level II–IV neck dissection. The risk of intra- and postoperative bleeding is high, and vascular ligation is often required. We evaluated the methods of vascular ligation and neck dissection in transoral robotic surgery for oropharyngeal cancer in Japan. The results show that a safe and minimally invasive treatment can be established if vascular ligation and neck dissection are performed based on appropriate case selection.

Background: Transoral robotic surgery (TORS) is a minimally invasive procedure that is performed with neck dissection (ND) and postoperative radiotherapy when necessary. This study aimed to review the methods of vascular ligation and ND in cases of TORS for oropharyngeal cancer in Japan. Methods: We enrolled 44 consecutive patients who underwent TORS for laryngopharyngeal cancer between December 2019 and December 2023. Of these, 35 patients who underwent TORS as a first-line treatment for oropharyngeal cancer were included in this study. We retrospectively collected patient data on age, sex, primary tumor location, clinical tumor–node classification, Eastern Cooperative Oncology Group performance status, history of irradiation to the neck, presence of anticoagulants, pathological results, tumor size, total operative duration, console time, length of skin incision operative result, estimated blood loss, late cervical lymph node metastasis, perioperative complications, postoperative hospital stay, postoperative bleeding, period until oral intake after surgery, and swallowing function. Intra- and postoperative outcomes of TORS, TORS + ND (IIa) + vascular ligation, and TORS + ND (II–IV) + vascular ligation. Results: Significant differences were found in operative duration, blood loss during ND, and skin incision length between TORS + ND (IIa) + vascular ligation and TORS + ND (II–IV) + vascular ligation. Console time and blood loss did not significantly differ between the two groups. Each group contained one case of postoperative bleeding. Conclusions: Safe and minimally invasive treatments can be established if vascular ligation and ND are implemented based on appropriate case selection.