Transcervical endoscopic retropharyngeal lymph node (RPLN) dissection in nasopharyngeal carcinoma with RPLN recurrence

Abstract

Background: Surgical access for retropharyngeal lymph node (RPLN) dissection is difficult. We aimed to examine the efficacy of transcervical endoscopic RPLN dissection (TSE-RPLND) for recurrent RPLN in nasopharyngeal carcinoma (NPC). Methods: From April 2013 to February 2019, a total of 31 patients with NPC diagnosed with RPLN recurrence underwent TSE-RPLND. The clinical characteristics, complications, and survival outcomes were retrospectively analyzed. Results: The mean duration of surgery, quantity of bleeding and postoperative hospitalization stay were 347.9 minutes, 107.7 mL, and 8.7 days, respectively. After a median follow-up of 31.0 months, the 2-year locoregional relapse-free survival, distant metastasis-free survival, progression-free survival, and overall survival rates were 63.9%, 95.2%, 59.9%, and 83.3%, respectively. The long-term incidences of swallowing problems, permanent nutrient tube, tongue atrophy, and shoulder problems were 6 (19.4%), 3 (9.7%), 3 (9.7%), and 3 (9.7%), respectively. Conclusions: TSE-RPLND is an effective method to treat RPLN recurrence in NPC, but nerve injury-related complications should not be ignored. You-Ping Liu, Shun-Lan Wang, Xiong Zou, and Rui You contributed equally to this study.

Effects of Swallowing Rehabilitation Training with a Balloon Dilation Therapy on the Deglutition Function and Quality of Life of Patients with Dysphagia after Radiotherapy for Nasopharyngeal Carcinoma

“…Inclusion criteria were as follows: (1) the patients who met the diagnostic criteria for NPC established by the American Joint Committee on Cancer and had dysphagia after radiotherapy, with symptoms such as hoarseness, difficulty eating, and salivation; (2) the patients who were treated at our hospital throughout the entire course of treatment without transfer; (3) the patients who had a Karnofsky performance score of ≥80; (4) the patients who had an expected survival of >3 months; and (5) the patients who were aged ≥18, with clear consciousness, stable vital signs, and were able to cooperate with the test. Exclusion criteria were as follows: (1) patients who were unable to communicate with others due to hearing disorders, speech disorders, unclear consciousness, mental illness, or other factors; (2) patients whose dysphagia was caused by cricopharyngeal achalasia revealed by fluoroscopy of swallowing; (3) patients with NPC recurrence; (4) patients who presented with dysphagia as the first symptom; (5) patients with oral or temporomandibular joint disease; (6) patients with severe cardiovascular diseases, acute infectious diseases, and acute attack of chronic diseases; (7) patients with other severe organic diseases; and (8) patients in pregnancy or lactation.…”

“…Dysphagia not only seriously affects the eating function but may also induce aspiration pneumonia and endanger the life of patients [ 6 ], making targeted treatment a requisite for patients' lives and health. Despite being the most common treatment for dysphagia at this stage, balloon dilatation, and the convenient and cheap treatment standing out distinctly from the rest, can effectively improve the function of the cricopharyngeal muscle but is still confined to its single treatment site and poor stimulation to other muscle tissues [ 5 , 7 ], which cannot improve the deglutition function of patients comprehensively and requires long-term and repeated performance in clinics. According to scholars Fong Raymond et al, swallowing rehabilitation training is necessary to improve dysphagia [ 8 ].…”

Contemporary management of the neck in nasopharyngeal carcinoma

“…The extent and principle of nodal dissection is similar to the methods employed for other recurrent HNSCC. However, RPLN, which is less often involved in HNSCC, can be resected via the maxillary swing approach 98 or more recently the trans‐cervical endoscopic approach 99,100 . Alternatively, a second course of RT (including a stereotactic approach and proton therapy) may be considered for a small solitary RPLN recurrence especially when surgical expertise is not available 101 …”

Anatomical studies and early results on endoscopic transoral medial pterygomandibular fold approach to salvage retropharyngeal lymphadenectomy in nasopharyngeal carcinoma

“…Retropharyngeal lymphadenectomy of retropharyngeal lymph nodes in NPC patients has been reported in only a few articles. [9][10][11] The transcervical and maxillary swing approaches are traditionally used for retropharyngeal lymphadenectomy in NPC patients. However, the transcervical approach requires a long path to access the lesion.…”

“…Recently, the transcervical endoscopic approach and transoral robotic retropharyngeal lymph node dissection have been developed. 10,11 Although the transcervical endoscopic approach is assisted by endoscopy, nerve injury and pharyngeal fistulas are still common. 11 For transoral robotic retropharyngeal lymph node dissection, it is sometimes difficult to precisely locate the retropharyngeal lymph node.…”