Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.
Laryngoscope. 2021 Jun;131(6):E1895-E1902. doi: 10.1002/lary.29319. Epub 2020 Dec 30.
Nasopharyngeal carcinoma (NPC) patients with retropharyngeal lymph node (RPLN) recurrence typically undergo reirradiation and experience severe radiotoxicity. Salvage open surgery is challenging because gaining access to the retropharyngeal space is complex and risky. Thus, only several centers can perform this procedure, and complications are common. We applied transoral robotic surgery RPLN dissection (TORS-RPLND) to NPC patients with RPLN recurrence to address the problem with open surgery.
From March 2017 to October 2020, 10 NPC patients with RPLN recurrence underwent TORS-RPLND using the da Vinci Si/Xi Surgical System. We applied the balloon occlusion test to protect the internal carotid artery, induction chemotherapy to shrink large tumors preoperatively, and ultrasound positioning to effectively locate unrecognizable RPLNs during surgery. Clinical characteristics, complications, and survival outcome data were retrospectively collected.
Of 10 patients, 8 underwent en bloc resection via TORS-RPLND, and the remaining 2 patients were converted to open surgery because we failed to identify the RPLN during TORS. After introducing intraoperative ultrasound positioning, no such failure occurred. The mean operative time and intraoperative blood loss were 297 ± 120 min and 40 ± 43 ml, respectively. All surgical margins were negative. TORS-related complications were mild, and the most severe one was grade 3 dysphagia in one patient who underwent conversion to open surgery (10%). With a median follow-up of 19 months, only 1 (10%) patient developed cervical recurrence.
TORS-RPLND is feasible, safe, and effective in the treatment of NPC patients with RPLN recurrence, especially with the help of intraoperative ultrasound positioning.
4 Laryngoscope, 131:E1895-E1902, 2021.
患有咽后淋巴结（RPLN）复发的鼻咽癌（NPC）患者通常需要进行再放疗，且会经历严重的放射性毒性。挽救性开放手术具有挑战性，因为进入咽后间隙的过程既复杂又有风险。因此，只有少数中心能够进行此手术，且并发症较为常见。我们应用经口机器人手术 RPLN 解剖术（TORS-RPLND）治疗 NPC 患者 RPLN 复发，以解决开放手术存在的问题。
自 2017 年 3 月至 2020 年 10 月，10 例 RPLN 复发的 NPC 患者采用 da Vinci Si/Xi 手术系统行 TORS-RPLND。我们应用球囊闭塞试验保护颈内动脉，诱导化疗使术前大肿瘤缩小，以及超声定位在术中有效定位无法识别的 RPLN。回顾性收集了临床特征、并发症和生存结果数据。
10 例患者中，8 例行 TORS-RPLND 整块切除，其余 2 例因 TORS 中无法识别 RPLN 而改行开放手术。引入术中超声定位后，未再发生此类失败。平均手术时间和术中失血量分别为 297±120 分钟和 40±43 毫升。所有手术切缘均为阴性。与 TORS 相关的并发症较轻，最严重的为 1 例改行开放手术的患者发生 3 级吞咽困难（10%）。中位随访 19 个月，仅 1 例（10%）患者发生颈部复发。
TORS-RPLND 治疗 NPC 患者 RPLN 复发是可行、安全且有效的，尤其在术中超声定位的帮助下。
4 Laryngoscope, 131:E1895-E1902, 2021.
