[Complication of transoral robotic surgery: single institution study]

Objective: To investigate the complications of transoral robotic surgery (TORS) and to identify the risk factors for the complications. Methods: This was a retrospective study of 134 cases of head and neck tumors underwent TORS at the Department of Surgery of Beijing United Family Hospital from September 2017 to June 2024. There were 9 cases of benign tumors and 125 cases of malignant tumors, including 119 squamous cell carcinomas, 3 adenocarcinomas, 2 lymphomas, and 1 sarcoma. There were 37 cases of pure TORS and 96 cases of TORS combined with neck dissection. Postoperative complications within 90 days were collected and graded with the Clavien-Dindo system. χ² test was used for statistical analysis. Results: A total of 25 (18.7%) cases experienced surgical complications, including 9 cases with Clavien-Dindo grade≥Ⅲ complications. Postoperative complications included 2 cases of death, 3 cases of massive hemorrhage, 3 cases of pharyngeal fistula, 2 cases of aspiration pneumonia, 2 cases of minor bleeding, 1 case of tooth injury, 1 case of arytenoid dislocation, 2 cases of tongue laceration, and 10 cases of long-term (>3 months) tracheostomy open. Postoperative pharyngeal fistula was significantly correlated with the scope of neck dissection (χ²=9.86, P<0.05), and Clavien-Dindo grade≥Ⅲ complications were significantly correlated with the scope of neck dissection (χ²=13.91, P<0.05) and tumor N stage (χ²=14.33, P<0.05). Conclusion: The high N-stage and neck dissection involving more than three regions are risk factors for the complications of TORS for head and neck tumors.