Head and Neck Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, UK.
Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Ann Surg Oncol. 2022 Nov;29(12):7881-7890. doi: 10.1245/s10434-022-12208-6. Epub 2022 Jul 16.
Retropharyngeal metastases are encountered in a variety of head and neck malignancies, imposing significant surgical challenges owing to their distinct location and proximity to neurovascular structures. Radiotherapy is the recommended treatment in most cases owing to its oncological efficacy. However, retropharyngeal irradiation affects the superior pharyngeal constrictor muscles and parotid glands, with the potential for long-term dysphagia and xerostomia. A younger oropharyngeal and thyroid cancer patient demographic is trending, fueling interest in treatment de-escalation strategies. Consequently, reducing radiotoxicity and its long-term effects is of special relevance in modern head and neck oncology practice. Through its unique ability to safely extirpate these traditionally difficult-to-access retropharyngeal lymph nodes via a natural orifice, TransOral Robotic Surgery (TORS) can considerably lower the surgical morbidity of retropharyngeal lymph node dissection (RPLND), compared with current existing approaches. This review summarizes the latest developments in the field, exposing current research gaps and discusses specific clinical settings where TORS could enable treatment de-escalation. In early-stage node-negative oropharyngeal cancer, single-modality surgical treatment with TORS RPLND may improve risk stratification of metastasis and recurrence in this region. TORS RPLND is also a potentially viable treatment option in salvage of an isolated retropharyngeal node recurrence or in the primary setting of a thyroid malignancy with a single positive retropharyngeal node. In time, TORS RPLND may provide an alternative de-escalation strategy in these three scenarios. However, with the reported morbidities, further prospective trials with long-term follow-up data are required to prove oncological safety and functional benefits over existing strategies.
咽后转移发生于多种头颈部恶性肿瘤中，由于其位置特殊且紧邻血管神经结构，因此手术极具挑战性。由于其抗肿瘤疗效，放疗是大多数情况下的推荐治疗方法。然而，咽后照射会影响咽上缩肌和腮腺，存在长期吞咽困难和口干的风险。具有年轻口咽和甲状腺癌患者特征的人群正在增加，这激发了人们对治疗降级策略的兴趣。因此，降低放射性毒性及其长期影响在现代头颈部肿瘤学实践中具有特殊意义。经口机器人手术（TORS）通过天然孔道安全地切除这些传统上难以触及的咽后淋巴结，与目前现有的方法相比，可显著降低咽后淋巴结清扫术（RPLND）的手术发病率。本文综述了该领域的最新进展，揭示了当前的研究空白，并讨论了 TORS 可在哪些特定临床情况下实现治疗降级的问题。在局部淋巴结阴性的早期口咽癌中，TORS RPLND 单一模式手术治疗可能改善该区域转移和复发的风险分层。TORS RPLND 也是孤立性咽后淋巴结复发或单一阳性咽后淋巴结甲状腺恶性肿瘤原发情况下的一种潜在可行的治疗选择。随着时间的推移，TORS RPLND 可能会在这三种情况下提供一种替代降级策略。然而，鉴于已报道的发病率，需要进一步开展具有长期随访数据的前瞻性试验，以证明其在现有的治疗策略中具有肿瘤安全性和功能优势。
