Han P, Liang F Y, Lin P L, Su Y J, Liu Y M, Huang X M
Department of Otolaryngology-Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510280, China Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou 510280, China.
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou 510280, China Department of Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510280, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 May 7;57(5):552-558. doi: 10.3760/cma.j.cn115330-20210804-00519.
To investigate the safety, efficacy, locally control and survival results of transoral Da Vinci robotic surgery for salvage treatment of locally recurrent nasopharyngeal carcinoma. This retrospective study included 33 patients with locally recurrent nasopharyngeal carcinoma (stage rT1-2, partial rT3) underwent transoral Da Vinci robotic surgery between October 2017 and January 2020. There were 20 males and 11 females, with an average age of (47.9±10.5) years. The lesions were localized in nasopharyngeal cavity in 14 cases, with extending to parapharyngeal space in 6 cases and the floor of sphenoid sinus in 13 cases. Transnasal endoscopy was used to assist surgery if necessary. SPSS 25.0 statistical software was used for statistical analysis. Transoral robotic nasopharyngectomy was successfully performed in all cases without conversion to open surgery, of which 13 cases were combined with transnasal endoscopic surgery. The average operation time was (126.2±30.0) min, ranging from 90 to 180 min. The postoperative pathological margin was R0 (31 cases) and R1 (2 cases), with no tumor residue. Complications of surgery mainly included symptoms of headache, nasal dryness and velopharyngeal insufficiency without nasopharyngeal hemorrhage. Follow-up time was from 3 to 54 months. One case had tumor recurrence 11 months after operation, 1 case had ipsilateral cervical lymph node metastasis 27 months after operation, 2 cases had distant metastasis and 1 case died of nasopharyngeal hemorrhage 3 months after operation. The 1-year, 2-year and 3-year overall survival rates were 97.0%, 96.0% and 92.9%, respectively and the local recurrence free rates were 97.0%, 95.7% and 91.7%, respectively. Transoral robotic nasopharyngectomy is safe and feasible for local recurrent nasopharyngeal carcinoma in selected patients, with higher local control rate and quality of life.
探讨经口达芬奇机器人手术挽救性治疗局部复发性鼻咽癌的安全性、有效性、局部控制情况及生存结果。本回顾性研究纳入了2017年10月至2020年1月期间接受经口达芬奇机器人手术的33例局部复发性鼻咽癌患者（rT1-2期，部分为rT3期）。其中男性20例，女性11例，平均年龄（47.9±10.5）岁。病变位于鼻咽腔14例，侵犯咽旁间隙6例，侵犯蝶窦底壁13例。必要时采用鼻内镜辅助手术。采用SPSS 25.0统计软件进行统计分析。所有病例均成功实施经口机器人鼻咽切除术，无一例中转开放手术，其中13例联合鼻内镜手术。平均手术时间为（126.2±30.0）分钟，范围为90至180分钟。术后病理切缘为R0（31例）和R1（2例），无肿瘤残留。手术并发症主要包括头痛、鼻干和腭咽功能不全症状，无鼻咽部出血。随访时间为3至54个月。1例术后11个月肿瘤复发，1例术后27个月同侧颈部淋巴结转移，2例远处转移，1例术后3个月死于鼻咽部出血。1年、2年和3年总生存率分别为97.0%、96.0%和92.9%，局部无复发生存率分别为97.0%、95.7%和91.7%。经口机器人鼻咽切除术对部分局部复发性鼻咽癌患者安全可行，局部控制率和生活质量较高。
