Transoral reconstruction of oropharyngeal tumors. The Hospital Clínic algorithm

Transoral approaches to the oropharynx have evolved rapidly in the past years. The development of technical instruments such as specific oropharyngeal retractors, 2D and 3D endoscopic systems, robotic platforms, and a combination of energies, has facilitated transoral resection and bleeding control. This new scenario has raised the need for new reconstructive alternatives after resection to achieve adequate oncologic and functional outcomes. The purpose of this work is to provide a guiding algorithm to plan the transoral resection and reconstruction of oropharyngeal tumors, based on the known anatomical landmarks that determine functionality after surgery. The Hospital Clínic transoral resection and reconstruction classification of the oropharynx (HC-TRR oropharynx) is based on the size and location of the defect after the surgery and considers the scenario of salvage surgery after radiotherapy failure. The reconstructive algorithm is adapted to the concept of a reconstructive ladder and represents a non-dogmatic and flexible vision that may facilitate clinical decision making.