Role of primary closure after transoral robotic surgery for tonsillar cancer

This study was performed to verify the efficacy and feasibility of primary closure for communication defects in the neck after transoral robotic surgery (TORS) for tonsillar cancer, and to verify the necessity of en bloc resection, which can create communication defects during TORS.

We applied a new primary closure technique in 13 cases of tonsillar cancer showing a communication defect with the neck after en bloc resection during TORS. This technique is composed of three steps: (1) suturing the remaining superior pharyngeal constrictor muscle and extrinsic tongue muscle complex; (2) suturing the digastric and mylohyoid muscles; and (3) securing reinforcement of the digastric-mylohyoid complex. We analyzed the medical records and pathology reports of these cases.

On pathology review, 69.2% of the patients developed invasion of the constrictor muscle. The mean defect size was 3.3 cm; the largest defect was 4.5 cm in diameter. In all patients, primary closure of the defect was possible. With regard to functional results, decannulation was possible within 1 week, oral feeding was possible within 9 days, and none of the patients showed pharyngocutaneous fistula formation. Two patients developed complications independent of the surgery itself.

The invasion rate of the pharyngeal constrictor muscle is high. Therefore, en bloc resection creating a communication defect during TORS should be considered in all cases of tonsillar cancer to secure safe margins. In addition, with our primary closure technique, even large defects can be closed without complication and with good preservation of function.