Airway management during transoral robotic surgery for head and neck cancers: a French GETTEC group survey

Valentine Poissonnet; Emilien Chabrillac; Philippe Schultz; Sylvain Morinière; Philippe Gorphe; Bertrand Baujat; Renaud Garrel; Audrey Lasne-Cardon; Alexandre Villeneuve; Guillaume Chambon; Nicolas Fakhry; Karine Aubry; Xavier Dufour; Olivier Malard; Romina Mastronicola; Benjamin Vairel; Patrice Gallet; Philippe Ceruse; Franck Jegoux; Jean Ton Van; Guillaume De Bonnecaze; Sébastien Vergez

doi:10.1007/s00405-021-07188-4

Airway management during transoral robotic surgery for head and neck cancers: a French GETTEC group survey

Eur Arch Otorhinolaryngol. 2022 Jul;279(7):3619-3627. doi: 10.1007/s00405-021-07188-4. Epub 2022 Jan 23.

Authors

Valentine Poissonnet¹, Emilien Chabrillac¹, Philippe Schultz², Sylvain Morinière³, Philippe Gorphe⁴, Bertrand Baujat⁵, Renaud Garrel⁶, Audrey Lasne-Cardon⁷, Alexandre Villeneuve⁸, Guillaume Chambon⁹, Nicolas Fakhry¹⁰, Karine Aubry¹¹, Xavier Dufour¹², Olivier Malard¹³, Romina Mastronicola¹⁴, Benjamin Vairel¹, Patrice Gallet¹⁵, Philippe Ceruse¹⁶, Franck Jegoux¹⁷, Jean Ton Van¹⁸, Guillaume De Bonnecaze¹, Sébastien Vergez^{19

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Affiliations

¹ Otolaryngology, Head and Neck Surgery Department, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, Toulouse, France.
² Otolaryngology, Head and Neck Surgery Department, Hautepierre Hospital, Strasbourg, France.
³ Otolaryngology, Head and Neck Surgery Department, University Hospital Bretonneau, Tours, France.
⁴ Otolaryngology, Head and Neck Surgery Department, Gustave Roussy Institute, Villejuif, France.
⁵ Otolaryngology, Head and Neck Surgery Department, Tenon Hospital, Paris, France.
⁶ Otolaryngology, Head and Neck Surgery Department, University Hospital of Montpellier, Montpellier, France.
⁷ Otolaryngology, Head and Neck Surgery Department, François Baclesse Centre, Caen, France.
⁸ Otolaryngology, Head and Neck Surgery Department, Georges-Pompidou European Hospital, Paris, France.
⁹ Otolaryngology, Head and Neck Surgery Department, University Hospital of Nîmes, Nîmes, France.
¹⁰ Otolaryngology, Head and Neck Surgery Department, University Hospital of Marseille, Marseille, France.
¹¹ Otolaryngology, Head and Neck Surgery Department, University Hospital Dupuytren, Limoges, France.
¹² Otolaryngology, Head and Neck Surgery Department, University Hospital of Poitiers, Poitiers, France.
¹³ Otolaryngology, Head and Neck Surgery Department, University Hospital of Nantes, Nantes, France.
¹⁴ Surgical Oncology, Head and Neck Surgery Department, Lorraine Oncology Institute, Vandoeuvre-lès-Nancy, France.
¹⁵ Otolaryngology, Head and Neck Surgery Department, University Hospital of Nancy, Nancy, France.
¹⁶ Otolaryngology, Head and Neck Surgery Department, University Hospital Lyon Sud, Lyon, France.
¹⁷ Otolaryngology, Head and Neck Surgery Department, Pontchaillou Hospital, Rennes, France.
¹⁸ Surgical Oncology Head and Neck Surgery Department, Oscar Lambret Centre, Lille, France.
¹⁹ Otolaryngology, Head and Neck Surgery Department, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, Toulouse, France. vergez.s@chu-toulouse.fr.
²⁰ Otolaryngology, Head and Neck Surgery Department, University Hospital Larrey, 24 chemin de Pouvourville, 31059, Toulouse Cedex 9, France. vergez.s@chu-toulouse.fr.

PMID: 35066651
DOI: 10.1007/s00405-021-07188-4

Abstract

Purpose: The aim of the survey was to define the indications for preventive tracheostomy in transoral robotic surgery (TORS) for head and neck cancers.

Methods: From October 2019 to January 2020, an online questionnaire was e-mailed to French surgical ENT teams with considerable experience of the TORS procedure (Gettec group). A descriptive analysis of the answers was performed.

Results: Eighteen French surgical teams answered the questionnaire. For 77.8% of the surgical teams, a past history of radiotherapy with residual edema was an indication for prophylactic tracheostomy, and for 88.9%, > 75 mg of antiplatelet medication or anticoagulation treatment was an indication.

Conclusion: Early preventive tracheostomy during TORS can protect airway from uncommon but potentially life-threatening complications, such as transoral hemorrhage or airway edema. We recommend it in high-risk situations, such as a past history of radiotherapy or antiplatelet therapy associated with large resections. Further studies are needed to establish evidence-based recommendations.

Keywords: Airway management; Head and neck cancer; Tracheostomy; Transoral robotic surgery.

MeSH terms

Head and Neck Neoplasms* / surgery
Humans
Retrospective Studies
Robotic Surgical Procedures* / methods
Surveys and Questionnaires
Tracheostomy