External Carotid Artery Ligation Versus Selective Artery Ligation in Transoral Surgery for Oropharyngeal Cancer.

Objective: Prophylactic ligation of the external carotid artery (ECA) during oropharyngeal squamous cell carcinoma (OPSCC) resection is known to reduce severe postoperative oropharyngeal bleeding events, however, there is limited research on whether bleed rates vary between selective ligation of individual vessels or total ligation of the ECA. This study assesses outcomes related to total versus selective ligation of the ECA in patients who underwent transoral resection for OPSCC of the base of tongue or palatine tonsils.

Methods: Retrospective review. Methods: Patients who underwent OPSCC resection of the base of tongue or palatine tonsils at a single institution between October 2019 and September 2023. Methods: Bleeding events within 30 days of surgery from the oropharyngeal surgical site were analyzed as well as other potential complications including stroke. Descriptive statistics and Fisher's exact test or χ2 testing were used to analyze the data.

Results: Of 140 patients, 51 underwent base of tongue resection, and 89 had tonsillar resection. Total ECA ligation was performed in 56 patients, while 80 had selective ligation. There was no significant difference in oropharyngeal bleeding between the 2 groups (total 3.8% vs selective 3.7% P > .05). One patient in the total ECA ligation group had a stroke after resection (1.9%). On multivariate analysis, age (P = .024) and radiation exposure (P = .011) were found to be significant risk factors for hemorrhage.

Conclusions: Selective ligation of external carotid vessels versus total ligation of the ECA shows similar rates of oropharyngeal bleeding without any significant risk of stroke.