Talk Description
Institution: Department of Otolaryngology, Head and Neck Surgery, St. Vincent’s Hospital, Sydney - NSW, Australia
Aim: Transoral robotic surgery(TORS), a minimally invasive treatment for HPV associated oropharyngeal squamous cell carcinoma(HPVOPSCC), has significantly transformed the field. Postoperative haemorrhage remains a clinically significant complication with Mayo Clinic staging system provides standardised classification. This study evaluates the prevalence and predictors of post-TORS haemorrhage in an Australian population.
Methodology: A retrospective cohort study was performed on HPVOPSCC patients undergoing TORS. Primary outcomes included haemorrhage prevalence, timing, and classification using the Mayo Clinic staging. Univariate analysis between haemorrhage and clinicopathological variables were assessed with chi-squared tests. Multivariable logistic regression was performed to identify predictors of haemorrhage, using odds ratios(OR) with 95% confidence intervals(CI).
Results: 247 patients underwent TORS, with haemorrhage occurring in 6.9% (n=17). Most events were low grade (Grade1–2), while high-grade haemorrhage (Grade≥3) occurred in 18%. One patient (0.4%) died secondary to haemorrhage. Primary haemorrhage occurred in 2.8%, with the remainder (4.0%) 2–3 weeks postoperatively. On univariate analysis, bleeding at presentation (p=0.018), requirement for further excision (p=0.003), extracapsular spread in the nodal basin (p=0.049), and positive margins (p=0.019) were associated with post-TORS haemorrhage. On multivariable analysis, significant predictors of post-TORS haemorrhage included requirement for further excision (OR8.41, 95%CI1.66–42.51), bleeding at presentation (OR5.68, 95%CI1.13–28.60) and extracapsular spread in the nodal basin (OR2.62, 95%CI1.01–6.77).
Conclusion: Post-TORS haemorrhage is an uncommon complication, with predominantly low-grade severity according to Mayo Clinic staging. However, clinically significant bleeding and rare mortality do occur. Standardised grading improves reporting consistency and may assist perioperative risk stratification.
Presenters
Authors
Authors
Dr Belen Weltman - , Dr Rhea Darbari Kaul - , Dr Peter Floros - , A/Prof Richard Gallagher - , Dr Julia Crawford -