鼻咽癌復發行內視鏡鼻咽切除手術－單一醫學中心經驗

背景：鼻咽癌在台灣有高於世界平均值的發生率，針對鼻咽癌復發的案例的救援性治療（salvage therapy），在臨床上仍面臨各種挑戰。內視鏡鼻咽切除手術已展現較低的侵入性、頗有潛力的術後癌症控制。本研究分享在成大醫學中心運用內視鏡鼻咽切除手術治療復發鼻咽癌的經驗。方法：這是一篇回顧性研究（retrospective research），回顧了成大醫學中心14個確診為復發性鼻咽癌，並於2017到2020年間接受過內視鏡鼻咽切除手術（endoscopic nasopharyngectomy）的病人。這些病例都接受過詳細的術前評估，來確定手術的可行性。我們蒐集這些案例的各式臨床資訊，並分析後續的術後成效，以及併發症的探討。結果：各個案例術後追蹤的時間長度涵括2年到64個月，一共有2個案例（14.3%）在1年內發生癌症復發，2年局部控制率（local control rates）為85.7%，2年無病存活率（disease-free survival rates）為85.7%，2年死亡率為7.1%。除1例發生皮瓣壞死的主要併發症（major complication）外，其餘輕微併發症以中耳積水為大宗（21.4%）。結論：相較於傳統的經外部路徑（external approach）鼻咽切除手術，內視鏡手術有其低侵略性、功能與美觀保存的優點，而術前對於腫瘤切除可行性的評估與重建考量都至關重要。然而針對2名術後復發且死亡之案例，對術後化療的反應也都不佳，未來除了增進內視鏡手術成效外，也盼能夠導入標靶或免疫療法來造福更多的病患。

關鍵字

nasopharyngeal carcinoma ； nasopharyngectomy ； endoscopic surgery（鼻咽癌；鼻咽切除手術；內視鏡手術）

並列摘要

BACKGROUND: The annual incidence of nasopharyngeal carcinoma (NPC) in Taiwan is 6.17 per 100,000 population/years. Radiotherapy and concurrent chemoradiotherapy currently constitute the main treatments. However, salvage management of locally recurrent NPC remains challenging; for example, reirradiation can cause cumulative toxicity. Surgical intervention is often required. Numerous studies have reported impressive outcomes following endoscopic nasopharyngectotmy, which is minimally invasive. This study reports our experiences of endoscopic nasopharyngectotmy in a tertiary medical center. METHODS: In this retrospective study, we reviewed 14 patients with locally recurrent NPC who received endoscopic nasopharyngectomy in National Cheng Kung University Hospital from 2017 to 2020. Preoperative patient selection was carefully performed to ensure oncologic safety. Surgical planning was developed on the basis of anatomic and oncologic factors. We collected and analyzed data regarding each patient's demographic variables, preoperative evaluation, surgical modality, pathologic margin, adjuvant chemotherapy, and postoperative outcomes and complications. RESULTS: The postoperative follow-up time ranged from 2 years to 64 months. Recurrence occurred in 2 cases (14.3%). Two-year local control rates were 85.7%, and 2-year disease-free survival rates were 85.7%. One patient exhibited flap failure and wound infection and was labelled as having major complications. However, the complications resolved successfully, and this patient did not experience recurrence. Other patients exhibited minor complications, such as otitis media effusion, neck stiffness, and sinusitis. CONCLUSIONS: The endoscopic approach is minimally invasive and has superior functional and cosmetic outcomes compared with the external approach. On the basis of the experience presented here, we would like to highlight the importance of patient selection and preoperative assessment in various dimensions. In addition to salvage endoscopic surgery, adjuvant chemotherapy or targeted therapy and immunotherapy is recommended for enhanced management of recurrent NPC.

並列關鍵字

nasopharyngeal carcinoma ； nasopharyngectomy ； endoscopic surgery

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