Salvage Surgery for Recurrent Nasopharyngeal Carcinoma

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Salvage Surgery for Recurrent Nasopharyngeal Carcinoma.

Independent Papers
Laryngoscope. 110(9):1483-1488, September 2000.
Shu, Chih-Hung MD; Cheng, Henrich MD; Lirng, Jiing-Feng MD; Chang,
Feng-Chi MD; Chao, Yee MD; Chi, Kwan-Hwa MD; Yen, Sang-Hue MD

Abstract:
Objective: To evaluate the efficacy of salvage surgery in the
treatment of recurrent nasopharyngeal carcinoma (NPC) at the primary site.

Study Design: A retrospective investigation of the outcome of salvage
surgery for 28 patients with recurrent NPC after definite radiation
therapy.

Methods: The nasopharynx was approached anteroposteriorly by the
transmaxillary approach (maxillary swing, maxillectomy) or inferior
approach (midline mandibulotomy or median labiomandibular glossotomy), or
laterally by modified facial translocation or transpterygoid approach;
intentional ligation of the internal carotid artery was performed after
establishment of extracranial-intracranial (EC-IC) bypass in one patient;
postoperative irradiation was given to the patients with positive
pathological margins.

Results: Nine patients lived without disease for 20 to 93 months (mean
interval, 52 mo) after surgery; among them, eight patients had T1 tumors
that were resected totally by surgery via anteroposterior approaches and
the other patient had postoperative irradiation to control the disease.
Seven patients had local recurrence 8 to 21 months after treatment. Four
patients developed distant metastases, including one patient with a T2b
tumor that was totally resected through modified facial translocation
approach with ligation of internal carotid artery. Eight patients died of
other causes; internal carotid artery blowout was the cause of death in
four of these eight patients.

Conclusions: In most cases of recurrence, T1 nasopharyngeal tumors can
be resected totally by anteroposterior approaches; for T2 or larger
tumors, postoperative irradiation is usually necessary. Otherwise, facial
translocation offers a better chance to completely resect the tumors.
Internal carotid artery is better ligated if patients have received
greater than 70 Gy irradiation or if the artery must be exposed during the
surgery. We suggest that EC-IC bypass be used to avoid the possible
complications (or cerebral ischemic stroke) caused by ligation of internal
carotid artery. The transmaxillary approach is favored in the management
of nasopharyngeal tumor recurrence with nasal cavity extension, and
midline mandibulotomy is more suitable for resection of posterior margin
of nasopharyngeal tumor recurrence. Facial translocation offers the widest
operative field and is the most versatile approach for radical resection
of nasopharyngeal tumor recurrence, but the surgeon should be skilled in
the management of the facial nerves to reduce morbidity.

(C) The American Laryngological, Rhinological & Otological Society,
Inc.



<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10983947&dopt=Abstract>

Laryngoscope. 2000 Sep;110(9):1483-8. Related Articles, Links
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Salvage surgery for recurrent nasopharyngeal carcinoma.

Shu CH, Cheng H, Lirng JF, Chang FC, Chao Y, Chi KH, Yen SH.

Department of Otolaryngology, Veterans General Hospital, Taipei and
National Yang-Ming University School of Medicine, Taiwan.

OBJECTIVE: To evaluate the efficacy of salvage surgery in the
treatment of recurrent nasopharyngeal carcinoma (NPC) at the primary site.
STUDY DESIGN: A retrospective investigation of the outcome of salvage
surgery for 28 patients with recurrent NPC after definite radiation
therapy.

METHODS: The nasopharynx was approached anteroposteriorly by the
transmaxillary approach (maxillary swing, maxillectomy) or inferior
approach (midline mandibulotomy or median labiomandibular glossotomy), or
laterally by modified facial translocation or transpterygoid approach;
intentional ligation of the internal carotid artery was performed after
establishment of extracranial-intracranial (EC-IC) bypass in one patient;
postoperative irradiation was given to the patients with positive
pathological margins.

RESULTS: Nine patients lived without disease for 20 to 93 months (mean
interval, 52 mo) after surgery; among them, eight patients had T1 tumors
that were resected totally by surgery via anteroposterior approaches and
the other patient had postoperative irradiation to control the disease.
Seven patients had local recurrence 8 to 21 months after treatment. Four
patients developed distant metastases, including one patient with a T2b
tumor that was totally resected through modified facial translocation
approach with ligation of internal carotid artery. Eight patients died of
other causes; internal carotid artery blowout was the cause of death in
four of these eight patients.

CONCLUSIONS: In most cases of recurrence, T1 nasopharyngeal tumors can be
resected totally by anteroposterior approaches; for T2 or larger tumors,
postoperative irradiation is usually necessary. Otherwise, facial
translocation offers a better chance to completely resect the tumors.
Internal carotid artery is better ligated if patients have received
greater than 70 Gy irradiation or if the artery must be exposed during the
surgery. We suggest that EC-IC bypass be used to avoid the possible
complications (or cerebral ischemic stroke) caused by ligation of internal
carotid artery. The transmaxillary approach is favored in the management
of nasopharyngeal tumor recurrence with nasal cavity extension, and
midline mandibulotomy is more suitable for resection of posterior margin
of nasopharyngeal tumor recurrence. Facial translocation offers the widest
operative field and is the most versatile approach for radical resection
of nasopharyngeal tumor recurrence, but the surgeon should be skilled in
the management of the facial nerves to reduce morbidity.

PMID: 10983947 [PubMed - indexed for MEDLINE]

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