Vessel Ligation in Transoral Robotic Surgery: Survey of the American Head and Neck Society

Objectives: Hemorrhage after transoral robotic surgery (TORS) surgery ranges from minor self-limited bleeding to lethal complications. To decrease risk, several publications have suggested ligation of the external carotid artery or its branches, even though statistically it has not been shown to be effective. The current study anonymously surveyed members of American Head and Neck Society (AHNS) on how they manage vessel ligation in TORS for oncological indications to better understand this practice.Methods: AHNS sent an email invitation to members with 2 weekly follow-up emails. Participants anonymously completed 10 questions regarding how long they have performed TORS, how many cancer-related TORS they have performed both overall and within the past year, timing of neck dissection, ligation of vessels, and changes in their practice.Results: In total, 165 surveys were completed by AHNS surgeons. The average respondent had performed TORS for 3–5 years and performs \u3c20 of cases for oncological purposes per year. Of the respondents, 83.7% ligate vessels. The most frequent vessels ligated were the lingual artery (77.7%), facial artery (63.3%), ascending pharyngeal artery (30.1%), superior thyroid artery (13.3%), and external carotid artery (9%). The most common reason for surgeons to ligate vessels was that it was either learned during training (28.3%) or incorporated due to suggestion or discussion with peers (28.3). Additionally, 14% were found to ligate after experiences related to fatal or near fatal patient events. Conclusions: Prophylactic vessel ligation is a common practice among AHNS surgeons. Training or discussion with peers is the most common reason for vessel ligation given, with the lingual artery being the most commonly ligated. However, the choice of which vessel to be ligated remains controversial. Further investigation should focus on the different individual vessels that are ligated and the affect that has on complication rates.https://scholarlycommons.henryford.com/merf2019clinres/1066/thumbnail.jp

The role of immune checkpoint inhibitors in anaplastic thyroid cancer (Case Series)

Anaplastic thyroid carcinoma (ATC) is a rare type of thyroid neoplasm. However, it is one of the most aggressive forms of malignancy accounting for approximately 50% of mortality associated with all thyroid cancers. Here we report two cases of ATC treated with immune checkpoint inhibitors. Next generation sequencing identified BRAFV600E mutation in one of the patients who also derived benefit from BRAF targeted therapy. We here discuss these cases highlighting the importance of expert pathological review, utilizing molecular testing to identify the underlying genetic targets for personalized therapy, and the potential role of PD-1 inhibitors for the treatment of ATC