[Indications for resection of parapharyngeal space tumors by transoral robotic surgery and prevention and treatment of complications]

Objective:This study investigated the clinical indications, prevention and management of common complications of TORS resection of parapharyngeal space tumors. Methods:The clinical data of 23 patients with parapharyngeal space tumors treated with TORS in the Eye & ENT Hospital of Fudan University from July 2020 to February 2022 were retrospectively analyzed. The surgical methods were divided into simple TORS surgery and TORS combined endoscopic or cervical surgery. The surgical incision can be directly sutured or partially sutured. If the surgical cavity is below the oropharyngeal plane and there is a risk of airway compression, preventive tracheotomy would be performed. No drainage（15 cases） or transnasal negative pressure drainage tube（8 cases） was placed in the operation cavity. In 17 cases, tumors were located between the top of nasopharynx and the lower boundary of oropharynx and these patients underwent simple TORS surgery; one case received combined cervical and endoscopic surgery, as the tumor was located near the skull base with unclear boundary with the deep lobe of parotid gland; five cases underwent combined endoscopic surgery, as the tumor reached the upper part of the nasopharynx or the outer part of the parapharyngeal space. Results:One case underwent emergency hemostasis for postoperative bleeding, and three cases underwent puncture and drainage for postoperative effusion. No complication occurred such as postoperative infection and airway obstruction. The healing grade of surgical incision and surgical cavity in transnasal drainage group was significantly better than that in non-drainage group. Conclusion:TORS operation is a safe and minimally invasive method in treating parapharyngeal space tumors with appropriate size and location. Postoperative effusion is a common complication after TORS. In case that surgical cavity extends to the deep parapharyngeal space or the lower part of the surgical cavity is beneath the surgical incision, the placement of transnasal negative pressure drainage tube after operation can improve postoperative recovery and reduce the incidence of complications such as effusion and infection.

[Postoperative prognostic risk factors and treatment strategies for patients with T3-T4 hypopharyngeal squamous cell carcinoma]

Objective:To investigate the independent prognostic risk factors and the application of different postoperative adjuvant treatment strategies on patients with T3-T4 hypopharyngeal carcinoma. Methods:Based on the inclusion criteria, we conducted a retrospective study that analyzed the clinical data of 229 cases who underwent surgery at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2003 to 2015. Risk factors for postoperative survival were analyzed by univariate and multivariate analysis and patients were stratified according to the independent risk factors. The efficacy of various postoperative adjuvant therapystrategies were compared in different risk groups. Results:Two hundred and twenty-nine patients with T3-T4 primary tumor had 3-year and 5-year overall survival rates of 39.07% and 29.03%, respectively; 3-year and 5-year recurrence-free survival rates were 40.22% and 30.29%, respectively. The results of multivariate analysis demonstrated that tumors in the posterior pharyngeal wall and posterior cricoid region, N2c-N3, lymphovascular invasion, and extranodal extension were independent risk factors. The utility of postoperative adjuvant therapy significantly improved postoperative survival in the high-risk group （P<0.05） and reduced postoperative recurrence significantly （P<0.01）. Patients received adjuvant chemoradiation had better survival than those received adjuvant radiation alone （P<0.05）. Postoperative adjuvant therapy had no significant effect on postoperative survival of patients in the low-risk group. Conclusion:Independent risk factors for patients with T3-T4 hypopharyngeal carcinoma include tumors in the posterior pharyngeal wall and posterior cricoid region, N2c-N3, lymphovascular invasion, as well as extranodal extension. Postoperative adjuvant therapy, especially adjuvant chemoradiation,is recommended for patient with risk factors mentioned above. For patients without those risk factors, postoperative follow-up and re-examination are recommended.

[Pathologic tumor volume predicting survival outcomes of patients with local advanced glottic carcinoma]

Objective:The aim of this study was to evaluate the predicting role of tumor volume as evaluated by postoperative pathologic examination on overall survival（OS） and disease free survival（DFS） in patients with local advanced glottic carcinoma. Methods:In this study, the records of 406 consecutive patients with local advanced glottic carcinoma（T3-T4 stages） who underwent surgery ± chemoradiotherapy from January 2005 to December 2010 were retrospectively reviewed and followed up. The demographic characteristics, disease staging, and pathologic tumor volume were analyzed. The optimal cutoff values of tumor volume for OS and DFS were obtained by using receiver operating characteristic（ROC） curves. The association of tumor volume with T stages were assessed by using Logistic regression model, and the relationship between tumor volume and OS and DFS rates were evaluated by using Cox regression models. Results:The 5-and 10-year OS rates were 62.9% and 55.4%, respectively. The 5-and 10-year DFS rates were 55.5% and 50.8%, respectively. The mean tumor volume was（5.1±6.7） cm³, T4 stage patients had higher tumor volume than those of patients with T3 stage（P<0.001）. The factor of tumor volume was correlated with T stages by using Logistic regression analyses（OR=13.81, 95%CI: 6.03-31.59, P<0.001）. The optimal cutoff values of tumor volume that were both at 3 cm³ for OS and DFS rates were obtained by using ROC curve plots. The OS and DFS rates of glottic carcinoma patients with tumor volume ≤ 3 cm³ were better when compared with those of patients with tumor volume>3 cm³（P<0.001）. Upon multivariate analyses, tumor volume was strongly correlated with poorer OS and DFS rates and remained independent prognostic factors for both the OS and DFS of patients with glottic carcinoma（OS: HR=1.59, 95%CI: 1.09-2.32, P＝0.017; DFS: HR=1.54, 95%CI: 1.08-2.20, P=0.016）. Conclusion:This study demonstrates that tumor volume is correlated with T stages, and this factor is an independent predictive factor of survival outcomes in patients with local advanced glottic carcinoma.