Management of the Airway in Transoral Robotic Surgery for Head and Neck Cancer

Aim of the study: To evaluate the safety and effectiveness of a conservative management of the airway without tracheotomy in a new transoral robotic surgery program for head and neck cancer. Materials and Method: Observational prospective study on a cohort without a control group. We included patients diagnosed of oropharyngeal, hypopharyngeal or laryngeal cancer who underwent transoral robotic surgery between July 2013 and July 2016. Results: Thirty-six patients met the inclusion criteria; 72% were oropharyngeal tumors (most frequently, 13 cases, tumors of the base of the tongue). The most frequent local extension was T2 (18 cases) but almost two-thirds (64%) were classified as advanced tumors (stages III and IV) due to the N stage. Lymph node surgery and transoral primary tumor surgery were staged when required. The intervention was successful in all cases. After robotic surgery, the patients in risk remained intubated for 24 hours. All were managed without a tracheostomy except for a patient with a synchronous diagnosis of sleep apnea (who received a temporary prophylactic tracheostomy) and a case of combined transoral-transcervical surgery (who received a non-programmed tracheotomy). There were no relevant perioperative incidences related to the airway except for a case of delayed bleeding. Conclusions: In our early experience, with a conservative management protocol with two-stage surgery and programmed postoperative intubation, transoral robotic surgery for oncological indications has been feasible and safe without a tracheotomy.