Chen Jiaming, Fang Jugao, Zhong Qi, Feng Ling, He Shizhi, Ma Hongzhi, Hou Lizhen, Lian Meng, Wang Ru, Shen Xixi, Yang Yifan
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Front Oncol. 2022 Feb 24;12:857445. doi: 10.3389/fonc.2022.857445. eCollection 2022.
To investigate a novel surgical approach of combined transcervical parapharyngeal space (PPS) with the transoral approach to dissect oropharyngeal cancer.
31 patients who were pathologically diagnosed with oropharyngeal cancer and had undergone surgical treatment in Beijing Tongren Hospital during June 2018 and December 2020 were enrolled. All patients were squamous cell carcinoma patients. There were 25 males and 6 females, and the age ranged between 44 and 70 years old. The number of patients with T1, T2, T3, and T4 stage disease was 8, 15, 8, and 0, respectively, according to the American Joint Committee on Cancer staging method, 8th edition. After the dissection of the submandibular and cervical lymph nodes, the parapharyngeal space was exposed, and the parapharyngeal space lymph node and the outer borderline of the tumor were dissected, and then the inner borderline of the tumor was dissected a transoral approach; the tumor was dissected en bloc, and the defects were reconstructed with the flap from the neck through the parapharyngeal space.
Among the patients enrolled, 21 were HPV positive and 10 were HPV negative. 8 patients were free of lymph node metastasis. The tumor resection margins were negative in all 31 patients. Safe and sufficient excision of tumors was feasible by this new surgical approach, avoiding complications associated with mandibulotomy or lip-splitting. All patients had no obvious dysfunctions of swallowing and voice. By the time of this follow-up, none died caused by OPSCC, and only two patients suffered from local recurrence. The 3-year survival rate is 100%, and the 3-year recurrence-free survival rate is 84.58%.
The surgical approach of combined transcervical parapharyngeal space with the transoral approach was effective and safe. On this basis, this approach has the advantage of fewer postoperative complications and better functional results.
探讨经颈联合咽旁间隙（PPS）与经口入路解剖口咽癌的新型手术方法。
纳入2018年6月至2020年12月在北京同仁医院接受手术治疗且经病理诊断为口咽癌的31例患者。所有患者均为鳞状细胞癌患者。其中男性25例，女性6例，年龄在44至70岁之间。根据美国癌症联合委员会第8版分期方法，T1、T2、T3和T4期疾病的患者数量分别为8例、15例、8例和0例。在解剖下颌下和颈部淋巴结后，暴露咽旁间隙，解剖咽旁间隙淋巴结和肿瘤的外侧边界，然后经口入路解剖肿瘤的内侧边界；将肿瘤整块切除，通过咽旁间隙用颈部皮瓣修复缺损。
纳入的患者中，21例人乳头瘤病毒（HPV）阳性，10例HPV阴性。8例患者无淋巴结转移。31例患者的肿瘤切缘均为阴性。通过这种新的手术方法能够安全、充分地切除肿瘤，避免了与下颌骨切开术或唇裂相关的并发症。所有患者吞咽和发声均无明显功能障碍。截至本次随访时，无患者因口咽鳞状细胞癌（OPSCC）死亡，仅2例患者出现局部复发。3年生存率为100%，3年无复发生存率为84.58%。
经颈联合咽旁间隙与经口入路的手术方法有效且安全。在此基础上，该方法具有术后并发症较少、功能效果较好的优势。
