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Valentini M, Lambertoni A, Sileo G, Arosio AD, Dalfino G, Pedretti F, Karligkiotis A, Bignami M, Battaglia P, Castelnuovo P, Turri-Zanoni M. Salvage endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma in a non-endemic area. Eur Arch Otorhinolaryngol 2024; 281:3601-3613. [PMID: 38480535 PMCID: PMC11211200 DOI: 10.1007/s00405-024-08500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/23/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE To analyze oncological outcomes of endoscopic surgical treatment of locally recurrent EBV-related undifferentiated non-keratinizing nasopharyngeal carcinoma (uNK-NPC) in a non-endemic area. METHODS Retrospective review of patients affected by recurrent uNK-NPC treated with nasopharyngeal endoscopic resection (NER) in a tertiary-care referral center from 2003 to 2022, by evaluating survival rates, prognostic factors, and follow-up strategies. RESULTS The oncological outcomes of 41 patients were analyzed, over a mean follow-up period of 57 months. The 5-year overall, disease-specific, and disease-free survival of the cohort were 60.7% ± 8.9%, 69% ± 9%, and 39.7% ± 9.2%, respectively. The local (rT) and regional (rN) extension of recurrent disease, stage of disease, and status of resection margins appeared to significantly influence survivals. After a mean follow-up period of 21 months, a further recurrence after NER was observed in 36.6% of cases. Skull base osteonecrosis induced by previous irradiation and post-surgical bone remodeling represent the major challenges for early detection of further local relapses during postoperative follow-up. CONCLUSION NER appeared as a safe and effective treatment for recurrent uNK-NPC. The adequate selection of patients eligible for NER is essential, to maximize the chances to cure and minimize the risk of local complications.
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Affiliation(s)
- Marco Valentini
- Department of Otolaryngology Head and Neck Surgery, Department of Biotechnology and Life Sciences, ASST Lariana, Ospedale Sant'Anna, University of Insubria, 22042, Como, San Fermo Della Battaglia, Italy.
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100, Varese, Italy.
| | - Alessia Lambertoni
- Department of Otorhinolaryngology Head and Neck Surgery, Ospedale di Circolo e Fondazione Macchi, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, 21100, Varese, Italy
| | - Giorgio Sileo
- Department of Otorhinolaryngology Head and Neck Surgery, Ospedale di Circolo e Fondazione Macchi, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, 21100, Varese, Italy
| | - Alberto Daniele Arosio
- Department of Otorhinolaryngology Head and Neck Surgery, Ospedale di Circolo e Fondazione Macchi, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, 21100, Varese, Italy
| | - Gianluca Dalfino
- Department of Otorhinolaryngology Head and Neck Surgery, Ospedale di Circolo e Fondazione Macchi, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, 21100, Varese, Italy
| | - Fabio Pedretti
- Department of Otolaryngology, University of Pavia, 27100, Pavia, Italy
| | - Apostolos Karligkiotis
- Department of Otorhinolaryngology Head and Neck Surgery, Ospedale di Circolo e Fondazione Macchi, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, 21100, Varese, Italy
| | - Maurizio Bignami
- Department of Otorhinolaryngology Head and Neck Surgery, Ospedale di Circolo e Fondazione Macchi, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, 21100, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100, Varese, Italy
| | - Paolo Battaglia
- Department of Otolaryngology Head and Neck Surgery, Department of Biotechnology and Life Sciences, ASST Lariana, Ospedale Sant'Anna, University of Insubria, 22042, Como, San Fermo Della Battaglia, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100, Varese, Italy
| | - Paolo Castelnuovo
- Department of Otorhinolaryngology Head and Neck Surgery, Ospedale di Circolo e Fondazione Macchi, Department of Biotechnology and Life Sciences, ASST Sette Laghi, University of Insubria, 21100, Varese, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100, Varese, Italy
| | - Mario Turri-Zanoni
- Department of Otolaryngology Head and Neck Surgery, Department of Biotechnology and Life Sciences, ASST Lariana, Ospedale Sant'Anna, University of Insubria, 22042, Como, San Fermo Della Battaglia, Italy
- Head and Neck Surgery and Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, 21100, Varese, Italy
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Mady LJ, Kaffenberger TM, Baddour K, Melder K, Godse NR, Gardner P, Snyderman CH, Solari MG, Kubik MW, Wang EW, Sridharan S. Anatomic Considerations of Microvascular Free Tissue Transfer in Endoscopic Endonasal Skull Base Surgery. Skull Base Surg 2022; 83:e143-e151. [DOI: 10.1055/s-0041-1722935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Objective Though microvascular free tissue transfer is well established for open skull base reconstruction, normative data regarding flap design and inset after endoscopic endonasal skull base surgery (ESBS) is lacking. We aim to describe anatomical considerations of endoscopic endonasal inset of free tissue transfer of transclival (TC) and anterior cranial base resection (ACBR) defects.
Design and Setting Radial forearm free tissue transfer (RFFTT) model.
Participants Six cadaveric specimens.
Main Outcome Measures Pedicle orientation, pedicle length, and recipient vessel intraluminal diameter.
Results TC and ACBR defects averaged 17.2 and 11.7 cm2, respectively. Anterior and lateral maxillotomies and endoscopic medial maxillectomies were prepared as corridors for flap and pedicle passage. Premasseteric space tunnels were created for pedicle tunneling to recipient facial vessels. For TC defects, the RFFTT pedicle was oriented cranially with the flap placed against the clival defect (mean pedicle length 13.1 ± 0.6 cm). For ACBR defects, the RFFTT pedicle was examined in three orientations with respect to anterior–posterior axis of the RFFTT: anteriorly, posteriorly, and laterally. Lateral orientation offered the shortest average pedicle length required for anastomosis in the neck (11.6 ± 1.29 cm), followed by posterior (13.4 ± 0.7cm) and anterior orientations (14.4 ± 1.1cm) (p < 0.00001, analysis of variance).
Conclusions In ACBR reconstruction using RFFTT, our data suggests lateral pedicle orientation shortens the length required to safely anastomose facial vessels and protects the frontal sinus outflow anteriorly while limiting pedicle exposure through a maxillary corridor within the nasal cavity. With greater understanding of anatomical factors related to successful preoperative flap planning, free tissue transfer may be added to the ESBS reconstruction ladder.
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Affiliation(s)
- Leila J. Mady
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, United States
| | | | - Khalil Baddour
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Katie Melder
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Neal R. Godse
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Paul Gardner
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Carl H. Snyderman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Mario G. Solari
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Mark W. Kubik
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Eric W. Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Shaum Sridharan
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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See A, Chu C, Kiong KL, Teo C, Tan HK, Wong EWY, Chan JYK, Tsang RKY, Chan J, Chang KP, Chien CY, Hao SP, Chen M, Lim CM. Surgical salvage of recurrent nasopharyngeal cancer- a multi-institutional review. Oral Oncol 2021; 122:105556. [PMID: 34688054 DOI: 10.1016/j.oraloncology.2021.105556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Anna See
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore; Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Clarisse Chu
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Kimberley L Kiong
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore; Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Constance Teo
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore; Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Hiang Khoon Tan
- Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore; Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Eddy W Y Wong
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, NT East, Hong Kong
| | - Jason Y K Chan
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, NT East, Hong Kong
| | - Raymond K Y Tsang
- Division of Otolaryngology, Department of Surgery, University of Hong Kong, Hong Kong
| | - Jimmy Chan
- Division of Otolaryngology, Department of Surgery, University of Hong Kong, Hong Kong
| | - Kai-Ping Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Sheng-Po Hao
- Department of Otolaryngology-Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Mingyuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chwee Ming Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore; Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore.
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Kang HJ, Park HJ, Lee DW, Tae K. Feasibility of transoral robotic nasopharyngectomy for recurrent nasopharyngeal carcinoma: how we do it. MINIM INVASIV THER 2019; 29:310-315. [DOI: 10.1080/13645706.2019.1637896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Hee Jeong Kang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hae Jin Park
- Department of Radiation Oncology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Dong Won Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Vastus Lateralis Muscle Free Flap for Skull Base Osteoradionecrosis in Nasopharyngeal Carcinoma. J Neurol Surg B Skull Base 2017; 79:349-352. [PMID: 30009115 DOI: 10.1055/s-0037-1608714] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022] Open
Abstract
Objectives To describe the first experience with a free vastus lateralis muscle-only flap to be used to cover and protect the exposed skull base and carotid artery from radiotherapy-induced skull base osteoradionecrosis (ORN). Design Retrospective review of a case series. Setting Tertiary academic medical center. Participants Post treatment nasopharyngeal carcinoma patients with skull base ORN. Main Outcome Measures Coverage of the internal carotid artery (ICA). Results Four patients underwent the procedure. Following the procedure, all patients were documented to have adequate viable soft tissue covering their ICA. Topical nasal steroids were prescribed to all patients as florid granulation tissue was noted to occur overlying the muscle flap in the early postoperative period. There were no flap failures. All patients noted an improvement in speech, cacosmia, and nasal crusting. No significant epistaxis occurred following surgery. Choanal stenosis was noted in three patients. Conclusion For skull base ORN resulting from the treatment of nasopharyngeal carcinoma (NPC) with radiotherapy that fails conservative management, an open approach to the nasopharynx, that allows debridement then placement of a vastus lateralis muscle-only free flap for coverage, offers a unique and viable approach to the management of this challenging condition.
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Song M, Chen WK, Zhang Q, Chen SW, Zhuang SM, Yang AK. Irradiation of the recipient site does not adversely affect successful free flap transfer in the repair of head and neck defects after salvage surgery for recurrent nasopharyngeal carcinoma originally treated with radiotherapy. J Plast Surg Hand Surg 2013; 47:40-5. [PMID: 23327790 DOI: 10.3109/2000656x.2012.729510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Irradiation of the recipient site has been associated with postoperative complications and an increased rate of flap failure in facial reconstruction. The aim of this study was to report the outcomes of our use of four different types of flaps (two free and two pedicled) for the reconstruction of patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy, who subsequently received salvage surgery after the development of recurrence or secondary primary tumours. The records of 12 NPC patients who underwent salvage surgery and reconstruction from 2002-2007 were retrospectively reviewed. There were no intraoperative or significant postoperative complications. All flaps survived. The average cosmetic outcome was 2.7 (1 = poor, 4 = excellent), all patients could tolerate a liquid to normal diet, and nine patients had normal or intelligible speech, while three exhibited slurred speech. These results indicate that the effects of irradiation on the recipient site do not appear to adversely affect successful flap transfer or outcomes.
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Affiliation(s)
- Ming Song
- Department of Head and Neck Surgery and State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, PR China
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Tsang RK, Mohr C. Lateral palatal flap approach to the nasopharynx and parapharyngeal space for transoral robotic surgery: a cadaveric study. J Robot Surg 2013; 7:119-23. [PMID: 23704859 PMCID: PMC3657084 DOI: 10.1007/s11701-012-0351-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/07/2012] [Indexed: 10/28/2022]
Abstract
The da Vinci surgical robot has been used for minimally invasive surgery of the head and neck region including resection of tumors in the nasopharynx. Access to and vision of the nasopharynx with the robot are difficult. A pure transoral approach and midline palatal split approach have been described. The disadvantage of these approaches is the limited lateral access to the parapharyngeal space. The objective of this study was to investigate the feasibility of accessing the nasopharynx and parapharyngeal space with a lateral palatal flap. Two complete nasopharyngectomies with resection of the parapharyngeal space and exposure of the internal carotid artery and branches of the mandibular nerves were performed on two fresh cadavers with the da Vinci surgical robot. The set up of the robot, the surgical procedure of elevating the lateral palatal flap, and robotic resection of the nasopharynx and parapharyngeal space are described.
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Affiliation(s)
- Raymond K. Tsang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Hong Kong, Queen Mary Hospital, 102, Pokfulam Road, Hong Kong, SAR, China
| | - Catherine Mohr
- Medical Research, Intuitive Surgical Inc., Sunnyvale, CA USA
- Stanford University School of Medicine, Palo Alto, CA USA
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Chen MY, Wang SL, Zhu YL, Shen GP, Qiu F, Luo DH, Chen QY, Jiang R, Cao KJ, Qian CN, Hong MH. Use of a posterior pedicle nasal septum and floor mucoperiosteum flap to resurface the nasopharynx after endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma. Head Neck 2011; 34:1383-8. [PMID: 22143978 DOI: 10.1002/hed.21928] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2011] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Endoscopic nasopharyngectomy is a new salvage treatment for locally recurrent nasopharyngeal carcinoma (NPC). However, how to resurface the nasopharyngeal defects in endoscopic endonasal approaches to avoid persistent postoperative headache, to the best of our knowledge, has not been reported. METHODS From September 2009 to August 2010, we used a modified posterior pedicle nasal septum and floor mucoperiosteum flap (nasal septum and floor flap, NSFF) after endoscopic nasopharyngectomy in 12 patients with locally recurrent NPC. Most of the nasal septum and floor mucoperiosteum, except for the posterior pedicle, was harvested to cover the nasopharyngeal defects. RESULTS All NSFFs successfully covered the entire nasopharyngeal defects and relined the nasopharynx with good functional recovery. The nasopharyngeal wounds recovered in 28 days (range, 14 to 56 days), and the donor-site wounds recovered in 46.5 days (range, 24-84 days). No reconstruction-related complications or disease recurrences were observed. CONCLUSION The NSFF is a safe and promising reconstructive option to resurface the nasopharyngeal defect after endoscopic nasopharyngectomy in patients with locally recurrent NPC.
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Affiliation(s)
- Ming-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, Peoples Republic of China.
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Chan JYW, Chow VLY, Tsang R, Wei WI. Nasopharyngectomy for locally advanced recurrent nasopharyngeal carcinoma: Exploring the limits. Head Neck 2011; 34:923-8. [DOI: 10.1002/hed.21855] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2011] [Indexed: 11/10/2022] Open
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Kakarala K, Richmon JD, Durand ML, Borges LF, Deschler DG. Reconstruction of a nasopharyngeal defect from cervical spine osteoradionecrosis. Skull Base 2011; 20:289-92. [PMID: 21311624 DOI: 10.1055/s-0030-1249244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Osteoradionecrosis of the cervical spine is a rare complication of radiation treatment of head and neck tumors that requires a multidisciplinary approach to management and reconstruction. The case of a 57-year-old man with osteoradionecrosis of the cervical spine secondary to radiation for metastatic hepatocellular carcinoma is presented. Operative debridement of the necrotic bone was performed and the nasopharyngeal soft tissue defect was reconstructed with a radial forearm free flap. The management and reconstruction options for osteoradionecrosis of the cervical spine are discussed.
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Affiliation(s)
- Kiran Kakarala
- Department of Otolaryngology, Division of Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
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Management of osteoradionecrosis of the jaws: An analysis of evidence. Eur J Surg Oncol 2008; 34:1123-34. [DOI: 10.1016/j.ejso.2008.03.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 03/26/2008] [Indexed: 11/17/2022] Open
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