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Original Investigation |

Analysis of Postoperative Bleeding and Risk Factors in Transoral Surgery of the Oropharynx

Taylor R. Pollei, MD1; Michael L. Hinni, MD1; Eric J. Moore, MD2; Richard E. Hayden, MD1; Kerry D. Olsen, MD2; John D. Casler, MD3; Logan C. Walter, BS1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Arizona, Phoenix
2Department of Otorhinolaryngology–Head and Neck Surgery, Mayo Clinic Rochester, Rochester, Minnesota
3Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Jacksonville, Jacksonville, Florida
JAMA Otolaryngol Head Neck Surg. 2013;139(11):1212-1218. doi:10.1001/jamaoto.2013.5097.
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Importance  With an increasing incidence of oropharyngeal carcinoma and prevalence of transoral surgical techniques, postoperative bleeding, with its associated risk factors, deserves evaluation.

Objective  To classify and review postoropharyngectomy hemorrhage rates and associated risk factors.

Design, Setting, and Participants  Single-institution, multicenter retrospective medical chart review analyzing surgical procedures in 906 patients treated with transoral surgery for oropharyngeal carcinoma at a tertiary care, academic referral center from 1994 to 2012. Tumor stage, previous treatment, resection method, and transcervical external carotid branch ligation were analyzed in relationship to postoperative hemorrhage rate, and severity. A novel classification system was created, grading bleeding episodes as minor, intermediate, major, or severe based on management method and related sequelae.

Results  Postoperative bleeding occurred in 5.4% of patients (49 of 906) with 67.3% of these (33 of 49) requiring operative intervention. Severe bleeding episodes were very rare (1.1% of patients). Transcervical external carotid system vessel ligation was performed with the primary resection in 15.6% of patients with no overall difference in bleeding rate or severity of bleeding in patients who underwent ligation vs those who did not (P = .21 and P = .66, respectively). Vessel ligation was performed more frequently in patients with a higher T stage (P = .002). In previously treated patients, severity of bleeding was decreased if vessels were ligated (P > .05). Higher T-stage tumors had a higher bleeding rate (P = .02). Bleeding rates were similar between those treated with laser (5.6%) and robotic (5.9%) oropharyngectomy (P = .80); however, patients with significantly higher T-stage tumors were treated with laser vs robot techniques (P < .001).

Conclusions and Relevance  Transoral resection of oropharyngeal carcinoma is safe, and severe life-threatening hemorrhage is rare. Although transcervical vessel ligation did not result in an overall decrease in bleeding rate, there is a trend toward reduced postoropharyngectomy bleeding severity with ligation. We recommend ligation for higher T-stage tumors, primary tonsil tumors, and patients undergoing revision surgery.

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Figures

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Figure 1.
Blood Supply to the Lateral Oropharynx

Reproduced with permission of the Mayo Foundation for Medical Education and Research. a.’s indicates arteries; m., muscle.

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Figure 2.
Facial and Lingual Artery Course

Reproduced with permission of the Mayo Foundation for Medical Education and Research. a.’s indicates arteries; m., muscle; n., nerve.

Graphic Jump Location

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