Transoral Resection for Oral Cancer
Transoral resection is surgery to help control or cure oral cancer. You may hear this surgery called TORS, or transoral robotic surgery, if the doctor is using small robotic tools to do the surgery. If lasers are used, it might be called transoral laser microsurgery (TLM). During surgery, the tumor is removed through the mouth. The tumor could be on the tongue, under the tongue, inside the cheek, or any place inside the mouth that's fairly easy to reach. Some healthy tissue around the tumor is also removed, to help make sure that no cancer cells remain. This sheet explains transoral resection and what to expect. After surgery, more cancer treatment may be needed, such as chemotherapy and radiation. Your healthcare provider will discuss your treatment plan with you.
Getting ready for surgery
Get ready for the procedure as you have been instructed. Be sure to tell your healthcare provider about all medicines you take. This includes over-the-counter medicines. It also includes herbs, vitamins, and other supplements. You may need to stop taking some or all of them before surgery. Also, follow any directions you’re given for not eating or drinking before surgery.
Before the surgery
The surgery takes 1 to 3 hours. Before the surgery begins:
An IV (intravenous) line is put into a vein in your arm or hand. It's used to give you fluids and medicines.
You will be given medicine (anesthesia) to keep you pain free during the surgery. You will have general anesthesia. This puts you into a deep sleep-like state during the surgery so you don't feel pain.
During the surgery
Here is what to expect during surgery:
An endoscope is put into your mouth. This is a thin flexible tube with a light and camera on the end. Your doctor will use it to get a close-up look at the tumor and the healthy tissue around it.
Small cuts (incisions) are made inside the mouth and the tumor is removed.
Some healthy tissue around the tumor is also removed. This is sent to a lab, where it’s checked for cancer cells.
The cut pieces of tissue are joined together with stitches (sutures). These dissolve on their own over time. In some cases, a small skin graft may be used to help fill in the area that was removed. The graft is stitched in place with sutures.
Depending on the tumor’s location, you may need a tracheostomy (trach) tube to help you breathe, or a feeding tube to help you eat. If one or both of these are needed, they will be put in at the end of the surgery. Your healthcare provider will tell you more.
After the surgery
You will be taken to a recovery room to wake up from the anesthesia. You may feel sleepy and nauseated right after surgery. You'll be given pain medicine. Let your healthcare providers know if your pain is not controlled. When you are ready, you will be taken to your hospital room and will likely stay for a few nights. When it’s time for you to be released from the hospital, have an adult family member or friend ready to drive you. Have someone stay with you for a few days to help care for you as your healing begins. If you’re going home with a trach tube or feeding tube, you will be shown how to care for these before you go home.
Recovering at home
Once at home, follow the instructions you have been given. Be aware that the surgery may affect your ability to swallow and to speak. You may be referred to a speech therapist, who can help you with these skills starting soon after surgery. During your recovery:
Take all antibiotics and pain medicine as directed.
You may have diarrhea from diet changes, stress, or an infection. Talk with a dietitian about what you can eat to reduce the chances of getting diarrhea.
You may have constipation from using opioid pain killers, from not moving much, or from not eating much. Talk with your healthcare provider or nurse about getting more fiber in your diet.
Resume your normal diet slowly. To protect your healing mouth, avoid spicy or acidic foods such as hot peppers, oranges, and tomatoes. Also avoid sharp, hard foods such as nuts and chips. Smooth soups, puddings, milkshakes, and blended fruit drinks will be easiest on your mouth.
Return to your normal daily routine when your healthcare provider says it’s OK. This includes work and exercise.
Don't drive until you are no longer taking pain medicines that make you drowsy.
When to call your healthcare provider
Be sure you have a contact number for your healthcare provider. After you get home, call if you have any of the following:
Chest pain or trouble breathing (call 911)
Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Pain that gets worse or is not relieved by pain medicines
Bleeding in the mouth
Choking on food or liquids
Severe nausea or vomiting
Leg pain or swelling
During follow-up visits, your healthcare provider will check on your healing. You will discuss treatment with radiation or chemotherapy, if needed. Regular checkups are very important. These help ensure that the cancer has not returned. Regular dental exams may be needed. If you smoke, talk to your healthcare provider about quitting. Smoking makes oral cancer treatment less effective. And it increases your risk for another tumor.
Risks and possible complications
Risks of transoral resection include:
Changes in taste
Trouble swallowing or speaking after healing (if part of the tongue is removed)
Nerve injury, causing numbness of the lip or tongue (may be temporary or permanent)
Breathing in (aspirating) food or liquids
Risks of anesthesia. You will discuss these with the anesthesiologist.
The cancer returns
Talk with your healthcare providers about what signs to look for and when to call them. Make sure you know what number to call with questions during office hours, evenings, and weekends.
January 19, 2018
Lam JS. Development of an online, patient-centred decision aid for patients with oropharyngeal cancer in the transoral robotic surgery era. Current Oncology. 2017;24(5):318-323
Gersten, Todd, MD,Stump-Sutliff, Kim, RN, MSN, AOCNS