CIO 2022-19 Embolization of the Lingual Artery in Transoral Robotic Surgery for Management of Recurrent Tongue Carcinomas

Purpose: The incidence of oropharyngeal carcinoma has been on the rise in recent decades. About 30% of patients who undergo definitive chemoradiation as the initial treatment present with residual or recurrent disease. In such a situation, surgical salvage either in the form of traditional open surgery or transoral robotic surgery (TORS) remains a viable treatment option. However, the extensive vascular supply of the posterior tongue and tonsillar bed increases the risk of perioperative bleeding, which is a key concern. The article describes the technique of selective preoperative embolization to reduce the risk of perioperative bleeding and enumerates its advantages in providing a bloodless field during surgery.

Materials and Methods: A prospective study was done of 320 patients with recurrent or residual midline base-of-tongue tumors who underwent TORS after selective lingual artery embolization at our center. We used 150- to 300-micron polyvinyl alcohol particles for lingual artery embolization.

Results: None of the patients had any major perioperative bleeding or postprocedural complications. All the patients after TORS had their tongue vascularity preserved with adequate recovery of tongue functions. Selective embolization of the feeder vessels provides a favorable bloodless surgical field without affecting the vascular integrity of the remnant tongue. This added advantage helps restore the normal oral phase of swallowing.

Conclusions: Advances in interventional radiology now allow selective embolization of feeder vessels and the tumor bed before surgery and help reduce the risk of a perioperative bleed.