Wang Zhi-Qiang, Xie Yu-Long, Liu You-Ping, Zou Xiong, Chen Jin-Hua, Hua Yi-Jun, Gu Yang-Kui, Ouyang Yan-Feng, Yu Zi-Kun, Sun Rui, Huang Pei-Yu, Chen Ming-Yuan
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P. R. China.
Otolaryngol Head Neck Surg. 2022 Mar;166(3):490-497. doi: 10.1177/01945998211011076. Epub 2021 Jun 29.
Salvage endoscopic nasopharyngectomy (ENPG) is a reasonable choice for resectable recurrent nasopharyngeal carcinoma (rNPC). However, in past decades, complete removal of the tumor was not feasible when the recurrent lesion was adjacent to the internal carotid artery (ICA). The present article introduces innovative strategies to ensure sufficient surgical margins while avoiding accidental injury to the ICA.
Retrospective study.
Tertiary care center.
We retrospectively reviewed rT2-3 rNPC patients with tumor lesions adjacent to the ICA (<5 mm) who underwent ENPG at the Sun Yat-sen University Cancer Center between January 2015 and June 2020. Thirty-seven patients were selected for this study. Seventeen patients underwent ENPG using direct dissection, 10 patients underwent endoscopic-assisted transcervical protection of the parapharyngeal ICA combined with ENPG, and 10 patients underwent ICA embolization followed by ENPG.
With a median follow-up duration of 31 months (range, 5 to 53 months), the 2-year overall survival, progression-free survival, locoregional recurrence-free survival, and distant metastasis-free survival rates of salvage ENPG for rNPC adjacent to the ICA were 88.7%, 72.0%, 72.0%, and 97.3%, respectively. The incidences of grade 1-2 and grade 3-5 postoperative complications were 16.2% and 13.5%, respectively. Two patients experienced ICA rupture during direct dissection but were out of danger after vascular embolization therapy. One patient had a positive margin. Two patients had severe nasopharyngeal wound infections with mucosal flap necrosis.
ENPG combined with ICA pretreatment allows the feasible and effective resection of rNPC lesions adjacent to the ICA.
挽救性内镜下鼻咽切除术（ENPG）是可切除复发性鼻咽癌（rNPC）的合理选择。然而，在过去几十年中，当复发病变毗邻颈内动脉（ICA）时，完全切除肿瘤是不可行的。本文介绍了创新策略，以确保足够的手术切缘，同时避免意外损伤ICA。
回顾性研究。
三级医疗中心。
我们回顾性分析了2015年1月至2020年6月在中山大学肿瘤防治中心接受ENPG的rT2-3期rNPC患者，这些患者的肿瘤病变毗邻ICA（<5mm）。本研究共纳入37例患者。17例患者采用直接解剖法进行ENPG，10例患者采用内镜辅助经颈保护咽旁ICA联合ENPG，10例患者先行ICA栓塞术，然后进行ENPG。
中位随访时间为31个月（范围5至53个月），ICA毗邻的rNPC挽救性ENPG的2年总生存率、无进展生存率、局部区域无复发生存率和远处转移无复发生存率分别为88.7%、72.0%、72.0%和97.3%。1-2级和3-5级术后并发症的发生率分别为16.2%和13.5%。2例患者在直接解剖过程中发生ICA破裂，但经血管栓塞治疗后脱离危险。1例患者切缘阳性。2例患者发生严重的鼻咽伤口感染伴黏膜瓣坏死。
ENPG联合ICA预处理可实现对毗邻ICA的rNPC病变进行可行且有效的切除。
