Salvage Transoral Robotic Surgery With Submental Flap Reconstruction: Functional and Oncologic Outcomes

Abstract

OBJECTIVE: Approximately 10% of recurrent oropharyngeal squamous cell carcinoma (OPSCC) cases undergoing salvage surgery require reconstruction. Treatment options include transoral robotic surgery (TORS) combined with microvascular free or pedicled flaps including the submental island flap (SMIF). This study evaluates perioperative, oncological, and functional outcomes of patients with recurrent OPSCC treated with TORS and SMIF reconstruction. METHODS: This retrospective cohort study included patients treated between 2019 and 2024. Perioperative, oncologic, and functional data were collected. Swallowing was evaluated with a video swallow study graded with the Dynamic Image Grade of Swallowing Toxicity (DIGEST) scoring system. A DIGEST-score increase of 2 points or more compared to baseline was considered a significant decrease in swallowing function. RESULTS: Eight patients were included. The mean time between initial OPSCC and recurrence was 4.7 years (SD = 3.1). Average operative time was 314 minutes (SD = 31.6). Three patients (37.5%) received a tracheostomy for 5 days. The median length of stay was 6.5 days (IQR = 6-7). Postoperative complications occurred in 2 patients (25%). Three patients (37.5%) underwent adjuvant therapy. During a follow-up time of 23.7 months (IQR = 19.1) 1 patient died due to disease. Patients required enteral feeding for a median of 43 days (IQR = 15-197). DIGEST-scores showed no significant change in swallowing at 6 weeks and 6 months compared to baseline. CONCLUSION: The SMIF is a reliable reconstructive option for salvage TORS-patients. It is readily available without microvascular expertise, provides healthy vascularized tissue that is outside the at-risk nodal basin, and results in excellent functional outcomes.