Safety of Non-robotic Transoral Surgeries for Pharyngolaryngeal Cancer: A Risk Factor Analysis of Complications Using Nationwide Claims Data

Background: Non-robotic transoral surgery (NRTOS) is the mainstream approach for pharyngolaryngeal cancer resection in Japan, whereas the da Vinci surgical system is not widely used. NRTOS employs reusable instruments, resulting in significantly lower costs than those of transoral robotic surgery (TORS). Given the comparable oncological outcomes, this study aimed to investigate the risk factors for complications and mortality following NRTOS as an alternative to TORS.

Patients And Methods: This retrospective cohort study utilized Japanese claims data from diagnosis procedure combination and receipt databases. Data from patients who underwent NRTOS between April 2020 and December 2022 were collected. The primary outcomes were postoperative bleeding, dysphagia, and laryngopharyngeal edema.

Results: Among the 336 included patients, 88.7% were male, with a median age of 72 years. The incidence rates of bleeding, dysphagia, and laryngopharyngeal edema after NRTOS were 3.3%, 4.2%, and 8.0%, respectively. Univariate logistic regression analysis revealed that history of hypertension [odds ratio (OR): 9.82, 95% confidence interval (CI): 1.24-77.50] was a possible risk factor for postoperative bleeding, while a disease stage ≥ T2 (OR: 5.37, 95% CI: 1.52-19.00), a body mass index < 18.5 kg/m (OR: 5.51, 95% CI: 1.46-20.80), and concurrent neck dissection with NRTOS (OR: 10.20, 95% CI: 3.26-32.10) were risk factors for postoperative dysphagia. No variables were identified as risk factors for laryngopharyngeal edema. Only one patient (0.3%) died during this study.

Conclusions: NRTOS demonstrated relatively low complication and mortality rates, establishing it as a safe technique for pharyngolaryngeal cancer resection.