Robotic‐Assisted Extended Sistrunk Approach ( RESA ) for Salvage Surgery After Head and Neck Irradiation

BACKGROUND: The robotic-assisted extended "Sistrunk" approach (RESA) is a minimally invasive technique providing access to hypopharyngeal and laryngeal structures via a submental incision and vallecular pharyngotomy, bypassing the base of tongue. METHODS: We report 10 RESA procedures in previously irradiated head and neck cancer patients, including six organ-preservation surgeries and four total laryngectomies. RESULTS: RESA enabled completion of the planned surgery, achieving R0 margins in all cases. Postoperative bleeding occurred in four patients (three Clavien-Dindo IIIb; one II). One cervical abscess was managed endoscopically. After total laryngectomy, three patients developed a subclinical pharyngeal dehiscence visualized on barium swallow exam, without evidence of a pharyngo-cutaneous fistula. Disease-specific survival was 100% (median 15.5 months); two patients died of unrelated causes. Swallowing improved or remained stable in seven patients at 1 year (three developed recurrence, a second primary, or died). CONCLUSION: RESA is a feasible salvage option with acceptable oncologic and functional outcomes in selected patients.