Transcervical arterial ligation for prevention of postoperative hemorrhage in transoral oropharyngectomy: Systematic review and meta-analysis

Background: Transcervical arterial ligation has been studied as a useful procedure to prevent bleeding events after transoral robotic surgery (TORS). Methods: A systematic review of English-language literature on arterial ligation in TORS from 2005 to 2019 was conducted using Cochrane, PubMed, Web of Science (WoS), and ScienceDirect databases. Studies evaluating ligation and rates of postoperative hemorrhage were included. Meta-analysis of included studies was performed to assess impact of ligation on postoperative hemorrhage. Results: Five studies with 2008 patients were included. History of radiation (odds ratio [OR] = 2.26, P =.02) and advanced tumor stage (OR = 1.93, P =.02) were found to predispose patients to postoperative hemorrhage. Arterial ligation was protective against severe hemorrhage in the mixed primary surgical modality cohort (OR = 0.33, P =.03) and in the TORS-only subgroup (OR = 0.21, P =.02), but did not significantly impact overall odds of postoperative hemorrhage. Conclusion: Transcervical arterial ligation offers protection against major/severe postoperative hemorrhage in patients undergoing TORS. Level of Evidence: II.