Reconstruction of hypopharynx after robotic versus conventional resection in hypopharyngeal cancer: a comparative pilot study.

Hypopharyngeal cancer often requires wide surgical resection with free flap reconstruction. Robotic approaches are increasingly adopted to improve surgical access and reduce visible scarring, but direct comparative outcomes with conventional transcervical methods in patients requiring complex pharyngeal reconstruction remain underexplored. This retrospective comparative pilot study analyzed 19 consecutive patients who underwent curative hypopharyngectomy with neck dissection and immediate microvascular free flap reconstruction at Yonsei University Severance Hospital (2020-2024). Patients were divided into robotic alternative approaches (retroauricular and minimal transcervical, n = 10) and conventional transcervical (n = 9) groups. Primary outcomes included major postoperative complications (saliva pooling, dysphagia, stricture) and hospital stay duration. No statistically significant differences were observed between groups regarding major complications, hospital stay, or operation time. Total resection was associated with increased dysphagia risk (OR: 20.71, p = 0.030). Patients with saliva pooling had longer hospital stays (median: 65.5 vs 30.0 days; p = 0.029). Immediate controlled pharyngostoma formation reduced hospital stay compared with delayed intervention (35.0 ± 4.2 vs 72.0 ± 26.9 days; p = 0.020). Robotic alternative approaches demonstrated outcomes comparable to conventional methods while providing superior cosmetic results. Prophylactic controlled pharyngostoma may benefit selected high-risk patients; larger studies are warranted to confirm these preliminary findings.