{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:44:56Z","timestamp":1785451496175,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T00:00:00Z","timestamp":1745539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Transoral robotic surgery (TORS) is a minimally invasive procedure that is performed with neck dissection (ND) and postoperative radiotherapy when necessary. This study aimed to review the methods of vascular ligation and ND in cases of TORS for oropharyngeal cancer in Japan. Methods: We enrolled 44 consecutive patients who underwent TORS for laryngopharyngeal cancer between December 2019 and December 2023. Of these, 35 patients who underwent TORS as a first-line treatment for oropharyngeal cancer were included in this study. We retrospectively collected patient data on age, sex, primary tumor location, clinical tumor\u2013node classification, Eastern Cooperative Oncology Group performance status, history of irradiation to the neck, presence of anticoagulants, pathological results, tumor size, total operative duration, console time, length of skin incision operative result, estimated blood loss, late cervical lymph node metastasis, perioperative complications, postoperative hospital stay, postoperative bleeding, period until oral intake after surgery, and swallowing function. Intra- and postoperative outcomes of TORS, TORS + ND (IIa) + vascular ligation, and TORS + ND (II\u2013IV) + vascular ligation. Results: Significant differences were found in operative duration, blood loss during ND, and skin incision length between TORS + ND (IIa) + vascular ligation and TORS + ND (II\u2013IV) + vascular ligation. Console time and blood loss did not significantly differ between the two groups. Each group contained one case of postoperative bleeding. Conclusions: Safe and minimally invasive treatments can be established if vascular ligation and ND are implemented based on appropriate case selection.<\/jats:p>","DOI":"10.3390\/cancers17091446","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T10:42:09Z","timestamp":1745577729000},"page":"1446","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy of Vascular Ligation for the Prevention of Intra- and Postoperative Bleeding in Transoral Robotic Surgery for Oropharyngeal Cancer"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9771-3880","authenticated-orcid":false,"given":"Tsutomu","family":"Ueda","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5873-9946","authenticated-orcid":false,"given":"Takayuki","family":"Taruya","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoru","family":"Hattori","sequence":"additional","affiliation":[{"name":"Center for Medical Education Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Chikuie","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayoshi","family":"Hattori","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9728-1264","authenticated-orcid":false,"given":"Takao","family":"Hamamoto","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0646-0839","authenticated-orcid":false,"given":"Takashi","family":"Ishino","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9853-2501","authenticated-orcid":false,"given":"Sachio","family":"Takeno","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1097\/01.MLG.0000170848.76045.47","article-title":"Transoral robotic surgery: Supraglottic laryngectomy in a canine model","volume":"115","author":"Weinstein","year":"2005","journal-title":"Laryngoscope"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1093\/jjco\/hyad168","article-title":"Transoral robotic surgery (TORS) in Japan: Procedures, advantages and current status","volume":"9","author":"Sano","year":"2024","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.anl.2023.11.001","article-title":"Useful combination of Gehanno method, polyglycolic acid sheet and fibrin glue for prevention of postoperative dysfunction after soft palate resection with TORS","volume":"51","author":"Tsukahara","year":"2024","journal-title":"Auris Nasus Larynx"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Sano, D., Shimizu, A., Tateya, I., Fujiwara, K., Kishimoto, Y., Maruo, T., Fujimoto, Y., Mori, T., Kato, H., and Tsukahara, K. (2021). Current Status of Transoral Surgery for Patients With Early-Stage Pharyngeal and Laryngeal Cancers in Japan. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.804933"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1001\/archoto.2012.1166","article-title":"Transoral robotic surgery alone for oropharyngeal cancer: An analysis of local control","volume":"138","author":"Weinstein","year":"2012","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"106610","DOI":"10.1016\/j.oraloncology.2023.106610","article-title":"Transoral robotic surgery without adjuvant therapy: A systematic review and meta-analysis of the association between surgical margins and local recurrence","volume":"147","author":"Williamson","year":"2023","journal-title":"Oral Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/lary.26796","article-title":"Quality of life outcomes of transoral robotic surgery with or without adjuvant therapy for oropharyngeal cancer","volume":"128","author":"Sethia","year":"2018","journal-title":"Laryngoscope"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1002\/hed.26902","article-title":"Transoral robotic surgery (TORS) using the da Vinci Xi: Prospective analysis of feasibility, safety, and outcomes","volume":"44","author":"Meulemans","year":"2022","journal-title":"Head Neck"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1002\/hed.26020","article-title":"Prophylactic arterial ligation following transoral robotic surgery: A systematic review and meta-analysis","volume":"42","author":"Bollig","year":"2020","journal-title":"Head Neck"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5067","DOI":"10.1007\/s00405-023-08108-4","article-title":"Staged neck dissection prior to transoral robotic surgery for oropharyngeal cancer: Does it reduce post-operative complication rates? A multi-centre study of 104 patients","volume":"280","author":"Blom","year":"2023","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1001\/jamaoto.2013.5097","article-title":"Analysis of postoperative bleeding and risk factors in transoral surgery of the oropharynx","volume":"139","author":"Pollei","year":"2013","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1200\/JCO.21.01961","article-title":"Randomized Trial of Radiotherapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Long-Term Results of the ORATOR Trial","volume":"40","author":"Nichols","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"109547","DOI":"10.1016\/j.radonc.2023.109547","article-title":"Treatment of oropharyngeal squamous cell carcinoma: Is swallowing quality better after TORS or RT?","volume":"183","author":"Campo","year":"2023","journal-title":"Radiother. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1002\/lary.30410","article-title":"Dysphagia and QoL 3\u2009Years After Treatment of Oropharyngeal Cancer With TORS or Radiotherapy","volume":"133","author":"Scott","year":"2023","journal-title":"Laryngoscope"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1002\/hed.26675","article-title":"Swallowing and communication outcomes following primary transoral robotic surgery","volume":"43","author":"Charters","year":"2021","journal-title":"Head Neck"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"107121","DOI":"10.1016\/j.ejso.2023.107121","article-title":"Neo-adjuvant chemotherapy and transoral robotic surgery in locoregionally advanced oropharyngeal cancer","volume":"49","author":"Costantino","year":"2023","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3429","DOI":"10.1002\/hed.26838","article-title":"Treatment outcomes of neoadjuvant chemotherapy and transoral robotic surgery in locoregionally advanced laryngopharyngeal carcinoma","volume":"43","author":"Solimeno","year":"2021","journal-title":"Head Neck"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1001\/jamaoto.2023.3781","article-title":"Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer","volume":"150","author":"Silver","year":"2024","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"106371","DOI":"10.1016\/j.oraloncology.2023.106371","article-title":"Neoadjuvant chemotherapy combined with transoral robotic surgery for stage III and IV laryngeal and hypopharyngeal carcinomas","volume":"140","author":"Sampieri","year":"2023","journal-title":"Oral Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1002\/hed.27904","article-title":"Neoadjuvant chemotherapy followed by transoral robotic surgery versus upfront surgery for locoregionally advanced oropharyngeal carcinoma: A propensity score matched analysis","volume":"47","author":"Sampieri","year":"2025","journal-title":"Head Neck"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Davies, J.C., Husain, Z., Day, T.A., Graboyes, E.M., and Eskander, A. (2022). Perioperative Mortality Risk in Patients Undergoing Transoral Robotic Surgery for T1-T2 Oropharyngeal Squamous Cell Carcinoma: A National Cancer Database Study. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.808465"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1111\/coa.13041","article-title":"Haemorrhage following transoral robotic surgery","volume":"43","author":"Hay","year":"2018","journal-title":"Clin. Otolaryngol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1177\/0194599813503446","article-title":"Surgeon experience and complications with Transoral Robotic Surgery (TORS)","volume":"149","author":"Chia","year":"2013","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.mayocp.2011.10.007","article-title":"Long-term functional and oncologic results of transoral robotic surgery for oropharyngeal squamous cell carcinoma","volume":"87","author":"Moore","year":"2012","journal-title":"Mayo Clin. Proc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1177\/0003489414558109","article-title":"Postoperative hemorrhage after transoral oropharyngectomy for cancer of the lateral oropharynx","volume":"124","author":"Laccourreye","year":"2015","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1002\/ohn.1117","article-title":"External Carotid Artery Ligation Versus Selective Artery Ligation in Transoral Surgery for Oropharyngeal Cancer","volume":"172","author":"Mackie","year":"2024","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.oraloncology.2017.04.014","article-title":"The impact of prophylactic external carotid artery ligation on postoperative bleeding after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma","volume":"70","author":"Gleysteen","year":"2017","journal-title":"Oral Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1002\/hed.26480","article-title":"Transcervical arterial ligation for prevention of postoperative hemorrhage in transoral oropharyngectomy: Systematic review and meta-analysis","volume":"43","author":"Sharbel","year":"2021","journal-title":"Head Neck"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2287","DOI":"10.1002\/lary.26626","article-title":"Postoperative hemorrhage and hospital revisit after transoral robotic surgery","volume":"127","author":"Zenga","year":"2017","journal-title":"Laryngoscope"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1002\/lary.28580","article-title":"Bleeding Complications After Transoral Robotic Surgery: A Meta-Analysis and Systematic Review","volume":"131","author":"Stokes","year":"2021","journal-title":"Laryngoscope"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/9\/1446\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:21:50Z","timestamp":1760030510000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/9\/1446"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,25]]},"references-count":30,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["cancers17091446"],"URL":"https:\/\/doi.org\/10.3390\/cancers17091446","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,25]]}}}