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

Published online by Cambridge University Press:  17 November 2023

Kai Xue ,
Juan Liu Open the ORCID record for Juan Liu [Opens in a new window] ,
Qiang Liu ,
Huan-Kang Zhang ,
Quan Liu ,
Jing Li ,
Xiao-Wen Jiang ,
Ke-Qing Zhao ,
Ye Gu  and
Xiao-Le Song
...Show all authors
Kai Xue
Affiliation:
Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
Juan Liu
Affiliation:
Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
Qiang Liu
Affiliation:
Department of Radiology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
Huan-Kang Zhang
Affiliation:
Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
Quan Liu
Affiliation:
Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
Jing Li
Affiliation:
Department of Otolaryngology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
Xiao-Wen Jiang
Affiliation:
Department of Otolaryngology, Huazhong University of Science and Technology Union Hospital (Nanshan Hospital), Shenzhen City, PR China
Ke-Qing Zhao
Affiliation:
Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
Ye Gu
Affiliation:
Department of Neurosurgery, Eye and ENT Hospital of Fudan University, Shanghai, PR China
Xiao-Le Song
Affiliation:
Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
Xi-Cai Sun*
Affiliation:
Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China
Hong-Meng Yu
Affiliation:
Department of Otolaryngology, Eye and ENT Hospital of Fudan University, Shanghai, PR China Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor (2018RU003), Chinese Academy of Medical Sciences, Shanghai, PR China
*
Corresponding author: Xi-Cai Sun; Email: laryngeal@163.com
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Abstract

Objective

Retropharyngeal lymphadenectomy is challenging. This study investigated a minimally invasive approach to salvage retropharyngeal lymphadenectomy in patients with nasopharyngeal carcinoma.

Methods

An anatomical study of four fresh cadaveric heads was conducted to demonstrate the relevant details of retropharyngeal lymphadenectomy using the endoscopic transoral medial pterygomandibular fold approach. Six patients with nasopharyngeal cancer with retropharyngeal lymph node recurrence, who underwent retropharyngeal lymphadenectomy with the endoscopic transoral medial pterygomandibular fold technique at the Eye and ENT Hospital of Fudan University from July to December 2021, were included in this study.

Results

The anatomical study demonstrated that the endoscopic transoral medial pterygomandibular fold approach offers a short path and minimally invasive approach to the retropharyngeal space. The surgical procedure was well tolerated by all patients, with no significant post-operative complications.

Conclusion

The endoscopic transoral medial pterygomandibular fold approach is safe and efficient for retropharyngeal lymphadenectomy.

Keywords

Nasopharyngeal carcinomalymphatic metastasisrecurrencelymph node excisionoral surgical proceduresendoscopyinternal carotid artery
Type
Main Article
Information
The Journal of Laryngology & Otology , First View , pp. 1 - 8
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

*

Joint first authors

#

Contributed equally to this work as corresponding authors.

Xi-Cai Sun takes responsibility for the integrity of the content of the paper

References

Cao, SM, Simons, MJ, Qian, CN. The prevalence and prevention of nasopharyngeal carcinoma in China. Chin J Cancer 2011;30:114–19CrossRefGoogle ScholarPubMed
Liu, LZ, Zhang, GY, Xie, CM, Liu, XW, Cui, CY, Li, L. Magnetic resonance imaging of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma: patterns of spread. Int J Radiat Oncol Biol Phys 2006;66:721–30CrossRefGoogle ScholarPubMed
Tang, LL, Guo, R, Zhou, G, Sun, Y, Liu, LZ, Lin, AH et al. Prognostic value and staging classification of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy. PLoS One 2014;9:e108375CrossRefGoogle ScholarPubMed
Wang, XS, Yan, C, Hu, CS, Ying, HM, He, XY, Zhou, ZR et al. Study of the medial group retropharyngeal node metastasis from nasopharyngeal carcinoma based on 3100 newly diagnosed cases. Oral Oncol 2014;50:1109–13CrossRefGoogle ScholarPubMed
Huang, L, Zhang, Y, Liu, Y, Li, H, Wang, S, Liang, S et al. Prognostic value of retropharyngeal lymph node metastasis laterality in nasopharyngeal carcinoma and a proposed modification to the UICC/AJCC N staging system. Radiother Oncol 2019;140:90–7CrossRefGoogle Scholar
Chen, B, Zhan, Z, Pan, J, Xiao, Y, Tang, L, Guo, Q et al. Re-evaluation of the prognostic significance of retropharyngeal node metastasis in nasopharyngeal carcinoma patients treated with intensity-modulated radiotherapy. Asia Pac J Clin Oncol 2022;18:e173–81CrossRefGoogle ScholarPubMed
Chen, YP, Chan, ATC, Le, QT, Blanchard, P, Sun, Y, Ma, J. Nasopharyngeal carcinoma. Lancet 2019;394:64–80CrossRefGoogle ScholarPubMed
Pfister, DG, Spencer, S, Adelstein, D, Adkins, D, Anzai, Y, Brizel, DM et al. Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020;18:873–98CrossRefGoogle ScholarPubMed
Chan, JY, Chow, VL, Wong, ST, Wei, WI. Surgical salvage for recurrent retropharyngeal lymph node metastasis in nasopharyngeal carcinoma. Head Neck 2013;35:1726–31CrossRefGoogle ScholarPubMed
Ding, X, Lin, QG, Zou, X, Liu, YP, Hua, YJ, Xie, YL et al. Transoral robotic retropharyngeal lymph node dissection in nasopharyngeal carcinoma with retropharyngeal lymph node recurrence. Laryngoscope 2021;131:E1895–902CrossRefGoogle ScholarPubMed
Liu, YP, Wang, SL, Zou, X, You, R, Yang, Q, Zhang, MX et al. Transcervical endoscopic retropharyngeal lymph node (RPLN) dissection in nasopharyngeal carcinoma with RPLN recurrence. Head Neck 2021;43:98–107CrossRefGoogle ScholarPubMed
Iavazzo, C, Papadopoulou, EK, Gkegkes, ID. Cost assessment of robotics in gynecologic surgery: a systematic review. J Obstet Gynaecol Res 2014;40:2125–34CrossRefGoogle ScholarPubMed
Coskun, HH, Ferlito, A, Medina, JE, Robbins, KT, Rodrigo, JP, Strojan, P et al. Retropharyngeal lymph node metastases in head and neck malignancies. Head Neck 2011;33:1520–9CrossRefGoogle ScholarPubMed
Ozlugedik, S, Ibrahim Acar, H, Apaydin, N, Firat Esmer, A, Tekdemir, I, Elhan, A et al. Retropharyngeal space and lymph nodes: an anatomical guide for surgical dissection. Acta Otolaryngol 2005;125:1111–15CrossRefGoogle ScholarPubMed
Hasegawa, Y, Matsuura, H. Retropharyngeal node dissection in cancer of the oropharynx and hypopharynx. Head Neck 1994;16:173–80CrossRefGoogle Scholar
Rouvière, H. Anatomy of the human lymphatic system. Br J Surg 1939;27:194–5Google Scholar
Chong, VF, Fan, YF, Khoo, JB. Retropharyngeal lymphadenopathy in nasopharyngeal carcinoma. Eur J Radiol 1995;21:100–5CrossRefGoogle ScholarPubMed
Gross, ND, Ellingson, TW, Wax, MK, Cohen, JI, Andersen, PE. Impact of retropharyngeal lymph node metastasis in head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 2004;130:169–73CrossRefGoogle ScholarPubMed
Mancuso, AA, Harnsberger, HR, Muraki, AS, Stevens, MH. Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer. Part I: normal anatomy. Radiology 1983;148:709–14Google Scholar
Morrissey, DD, Talbot, JM, Cohen, JI, Wax, MK, Andersen, PE. Accuracy of computed tomography in determining the presence or absence of metastatic retropharyngeal adenopathy. Arch Otolaryngol Head Neck Surg 2000;126:1478–81CrossRefGoogle ScholarPubMed
Amatsu, M, Mohri, M, Kinishi, M. Significance of retropharyngeal node dissection at radical surgery for carcinoma of the hypopharynx and cervical esophagus. Laryngoscope 2001;111:1099–103CrossRefGoogle ScholarPubMed
Ferlito, A, Shaha, AR, Rinaldo, A. Retropharyngeal lymph node metastasis from cancer of the head and neck. Acta Otolaryngol 2002;122:556–60CrossRefGoogle ScholarPubMed
Butta, L, Lombardi, D, Marconi, A, Nicolai, P. Transoral excision of a retropharyngeal lymph node under rigid endoscopic control. Ann Otol Rhinol Laryngol 2010;119:211–14CrossRefGoogle ScholarPubMed
Teshima, M, Otsuki, N, Shinomiya, H, Morita, N, Furukawa, T, Morimoto, K et al. Impact of retropharyngeal lymph node dissection in the surgical treatment of hypopharyngeal cancer. Head Neck 2019;41:1738–44CrossRefGoogle ScholarPubMed
Togashi, T, Sugitani, I, Toda, K, Kawabata, K, Takahashi, S. Surgical management of retropharyngeal nodes metastases from papillary thyroid carcinoma. World J Surg 2014;38:2831–7CrossRefGoogle ScholarPubMed
Katori, Y, Kawase, T, Cho, KH, Abe, H, Rodriguez-Vazquez, JF, Murakami, G et al. Prestyloid compartment of the parapharyngeal space: a histological study using late-stage human fetuses. Surg Radiol Anat 2012;34:909–20CrossRefGoogle ScholarPubMed
Maglione, MG, Guida, A, Pavone, E, Longo, F, Aversa, C, Villano, S et al. Transoral robotic surgery of parapharyngeal space tumours: a series of four cases. Int J Oral Maxillofac Surg 2018;47:971–5CrossRefGoogle ScholarPubMed
Oikawa, Y, Michi, Y, Tsushima, F, Tomioka, H, Mochizuki, Y, Kugimoto, T et al. Management of retropharyngeal lymph node metastasis in oral cancer. Oral Oncol 2019;99:104471CrossRefGoogle ScholarPubMed
Prades, JM, Gavid, M, Asanau, A, Timoshenko, AP, Richard, C, Martin, CH. Surgical anatomy of the styloid muscles and the extracranial glossopharyngeal nerve. Surg Radiol Anat 2014;36:141–6CrossRefGoogle ScholarPubMed
Chen, YJ, Wang, CP, Wang, CC, Jiang, RS, Lin, JC, Liu, SA. Carotid blowout in patients with head and neck cancer: associated factors and treatment outcomes. Head Neck 2015;37:265–72CrossRefGoogle ScholarPubMed
McDonald, MW, Moore, MG, Johnstone, PA. Risk of carotid blowout after reirradiation of the head and neck: a systematic review. Int J Radiat Oncol Biol Phys 2012;82:1083–9CrossRefGoogle ScholarPubMed
Yang, R, Wu, H, Chen, B, Sun, W, Hu, X, Wang, T et al. Balloon test occlusion of internal carotid artery in recurrent nasopharyngeal carcinoma before endoscopic nasopharyngectomy: a single center experience. Front Oncol 2021;11:674889CrossRefGoogle ScholarPubMed
Sun, X, Yan, B, Truong, HQ, Borghei-Razavi, H, Snyderman, CH, Fernandez-Miranda, JC. A comparative analysis of endoscopic-assisted transoral and transnasal approaches to parapharyngeal space: a cadaveric study. J Neurol Surg B Skull Base 2018;79:229–40CrossRefGoogle ScholarPubMed
Paulsen, F, Tillmann, B, Christofides, C, Richter, W, Koebke, J. Curving and looping of the internal carotid artery in relation to the pharynx: frequency, embryology and clinical implications. J Anat 2000;197(Pt 3):373–81CrossRefGoogle Scholar
Fang, X, Di, G, Zhou, W, Jiang, X. The anatomy of the parapharyngeal segment of the internal carotid artery for endoscopic endonasal approach. Neurosurg Rev 2020;43:1391–401CrossRefGoogle ScholarPubMed