Endoscopic Nasopharyngectomy Combined With Internal Carotid Artery Pretreatment for Recurrent Nasopharyngeal Carcinoma
Endoscopic Nasopharyngectomy Combined With Internal Carotid Artery Pretreatment for Recurrent Nasopharyngeal Carcinoma
复制标题
内镜鼻咽切除术联合颈内动脉预处理治疗复发鼻咽癌
DOI：
10.1177/01945998211011076
复制
发表时间：
2021-06-29
影响因子：
3.4
通讯作者：
Chen, Ming-Yuan
中科院分区：
文献类型：
--
作者：
Wang, Zhi-Qiang;Xie, Yu-Long;Chen, Ming-Yuan
目的挽救性鼻咽内镜切除术（ENPG）是可切除复发性鼻咽癌（rNPC）的合理选择。然而，在过去的几十年里，当复发病灶靠近颈内动脉（ICA）时，完全切除肿瘤是不可行的。本文介绍了创新的策略，以确保足够的手术切缘，同时避免意外伤害的ICA。研究设计回顾性研究。三级护理中心设置。方法回顾性分析2015年1月至2020年6月在中山大学肿瘤中心接受ENPG治疗的肿瘤病变邻近ICA （< 5mm）的rT2-3型rNPC患者。37例患者入选本研究。17例患者采用直接剥离法进行ENPG， 10例患者采用内镜辅助下经颈保护咽旁ICA联合ENPG， 10例患者采用ICA栓塞后进行ENPG。结果中位随访时间为31个月（范围5 ~ 53个月），补救性ENPG治疗ICA附近rNPC的2年总生存率、无进展生存率、局部无复发生存率和远处无转移生存率分别为88.7%、72.0%、72.0%和97.3%。术后1-2级和3-5级并发症发生率分别为16.2%和13.5%。2例患者在直接剥离过程中发生ICA破裂，经血管栓塞治疗后脱离危险。一名患者的切缘呈阳性。2例患者出现严重鼻咽创面感染伴黏膜瓣坏死。结论ENPG联合ICA预处理可有效切除ICA附近的rNPC病变。
Objective 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. Study Design Retrospective study. Setting Tertiary care center. Methods 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. Results 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. Conclusion ENPG combined with ICA pretreatment allows the feasible and effective resection of rNPC lesions adjacent to the ICA.