Robot-assisted versus conventional neck dissection in head and neck cancers: A systematic review and meta-analysis

Background

Advances in technology have enabled neck dissection techniques that reduce aesthetic impact while maintaining oncological safety. This study compares perioperative outcomes between robotic neck dissection via retroauricular/modified facelift incision (RNDRM) and conventional neck dissection via anterolateral cervical incision (CND).

Methods

Studies were selected from PubMed, Embase, and Cochrane Library. Data from studies comparing RNDRM and CND were extracted and analyzed using a random-effects model.

Results

The meta-analysis included eight studies with 421 cases. The RNDRM group had a longer operative time (mean difference [MD], 69.11; 95 % confidence interval [CI] 37.92 to 100.30) and higher cosmetic satisfaction (MD, 2.03; 95 % CI, 1.48 to 2.57), along with a higher risk of marginal mandibular nerve injury (risk difference [RD], 0.08; 95 % CI 0.01 to 0.15). No significant differences were found in operative blood loss (MD, 15.35; 95 % CI − 7.39 to 38.10), days of drain placement (MD, 0.49; 95 % CI, −0.02 to 1.00), drainage volume (MD, 15.29; 95 % CI, −45.22 to 75.79), overall lymph node yield (MD, −1.09; 95 % CI, −3.18 to 1.00), positive lymph node yield (MD, −0.61; 95 % CI, −2.20 to 0.98), length of hospital stay (MD, 1.07; 95 % CI −0.06 to 2.20), or regional recurrence (RD, 0.00; 95 % CI −0.05 to 0.05), with similar rates of other complications.

Conclusion

RNDRM offers better cosmetic outcomes but requires longer operative time and has a higher risk of marginal mandibular nerve injury than CND. It may be an alternative for selected patients, with surgery choice needing discussion between patient and surgeon.