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Objective: Endoscopic nasopharyngectomy (ENPG) with en bloc resection has been well accepted in resectable localized recurrent nasopharyngeal carcinoma (rNPC), but it is a difficult technique to master for most otorhinolaryngology head and neck surgeons. Ablation surgery is a new and simplified method to remove tumors. We designed a novel method using low‐temperature plasma radiofrequency ablation (LPRA) and evaluated the survival benefit. Methods: A total of 56 localized rNPC patients were explained in detail and retrospectively analyzed. The surgery method was ablated from the resection margin to the center of the tumor. The postmetastatic overall survival (OS), local relapse‐free survival (LRFS) rate, progression‐free survival (PFS) and distant metastasis‐free survival (DMFS) were analyzed using the Kaplan–Meier method and compared by the log‐rank test. Results: All surgeries were successfully performed without any severe postoperative complications or deaths. The median operation time of ablation and harvested NSFF respectively were 29 min (range, 15–100 min) and 101 min (range, 30–180 min). The average number of hospital days postoperation was 3 days (range, 2–5 days). All cases (100.0%) had radical ablation with negative resection margins. The nasopharyngeal defects were completely re‐epithelialized in 54 (96.4%) patients. As of the data cutoff (September 3, 2023), the median follow‐up time was 44.3 months (range, 17.1–52.7 months, 95% CI: 40.4–48.2). The 3‐year OS, LRFS, PFS and DMFS of the entire cohort were 92.9% (95% CI: 0.862–0.996), 89.3% (95% CI: 0.813–0.973), 87.5% (95% CI: 0.789–0.961), and 92.9% (95% CI: 0.862–0.996), respectively. Cycles of radiotherapy were independent risk factors for OS (p = 0.003; HR, 32.041; 95% CI: 3.365–305.064), LRFS (p = 0.002; HR, 10.762; 95% CI: 2.440–47.459), PFS (p = 0.004; HR, 7.457; 95% CI: 1.925–28.877), and DMFS (p = 0.002; HR, 34.776; 95% CI: 3.806–317.799). Conclusion: Radical endoscopic nasopharyngectomy by using low‐temperature plasma radiofrequency ablation is a novel, safe and simplified method to master and disseminate for treating resectable rNPC. However, further data and longer follow‐up time are needed to prove its efficacy. [ABSTRACT FROM AUTHOR]

Objective: Postradiation nasopharyngeal necrosis (PRNN) frequently develops after second‐course radiotherapy for nasopharyngeal carcinoma (NPC). PRNN can lead to internal carotid artery (ICA) massive hemorrhage due to ICA rupture, resulting in sudden death. This study aims to explore the pretreatment of the ICA to prevent fatal massive hemorrhage in PRNN patients. Study Design: Retrospective cohort study. Setting: Sun Yat‐sen University Cancer Center. Methods: Patients diagnosed with NPC and PRNN from January 2010 to September 2022 were included. The Cox proportional hazards regression analysis was performed to analyze risk factors for massive hemorrhage and survival. A nomogram was developed to integrate prognostic models and perform parameter calibration. Results: Two hundred and fifty‐four PRNN patients were included in this study. Prophylactic ICA occlusion significantly reduced the risk of ICA hemorrhage compared to no prophylactic ICA occlusion (3.6% vs 40.6%, P <.001). Surgical repair on necrosis significantly prevented hemorrhage and improved survival. The nomogram, incorporating the above 2 factors and the nearest distance from necrosis to ICA ≤ 3 mm, exhibited excellent discriminative ability for hemorrhage. We identified 3 high‐risk factors that indicate the need for prophylactic ICA management in PRNN patients: (1) exposure of ICA by rhinoscopy; (2) signs of ICA erosion on MRA scanning; (3) the depth of soft tissue coverage surrounding the ICA wall within the necrotic cavity is less than 3 mm on magnetic resonance imaging. Conclusion: We have identified 3 high‐risk factors for PRNN patients that necessitate prophylactic ICA management. These findings are expected to contribute to improving the quality of life and overall survival of PRNN patients. [ABSTRACT FROM AUTHOR]

Objective: Salvage endoscopic nasopharyngectomy (ENPG) is a reasonable choice for resectable recurrent nasopharyngeal carcinoma (rNPC). However, in past decades, complete removal of the tumor was not feasible when the recurrent lesion was adjacent to the internal carotid artery (ICA). The present article introduces innovative strategies to ensure sufficient surgical margins while avoiding accidental injury to the ICA. Study Design: Retrospective study. Setting: Tertiary care center. Methods: We retrospectively reviewed rT2-3 rNPC patients with tumor lesions adjacent to the ICA (<5 mm) who underwent ENPG at the Sun Yat-sen University Cancer Center between January 2015 and June 2020. Thirty-seven patients were selected for this study. Seventeen patients underwent ENPG using direct dissection, 10 patients underwent endoscopic-assisted transcervical protection of the parapharyngeal ICA combined with ENPG, and 10 patients underwent ICA embolization followed by ENPG. Results: With a median follow-up duration of 31 months (range, 5 to 53 months), the 2-year overall survival, progression-free survival, locoregional recurrence-free survival, and distant metastasis-free survival rates of salvage ENPG for rNPC adjacent to the ICA were 88.7%, 72.0%, 72.0%, and 97.3%, respectively. The incidences of grade 1-2 and grade 3-5 postoperative complications were 16.2% and 13.5%, respectively. Two patients experienced ICA rupture during direct dissection but were out of danger after vascular embolization therapy. One patient had a positive margin. Two patients had severe nasopharyngeal wound infections with mucosal flap necrosis. Conclusion: ENPG combined with ICA pretreatment allows the feasible and effective resection of rNPC lesions adjacent to the ICA. [ABSTRACT FROM AUTHOR]

Objectives: Nasopharyngeal carcinoma (NPC) patients with retropharyngeal lymph node (RPLN) recurrence typically undergo reirradiation and experience severe radiotoxicity. Salvage open surgery is challenging because gaining access to the retropharyngeal space is complex and risky. Thus, only several centers can perform this procedure, and complications are common. We applied transoral robotic surgery RPLN dissection (TORS‐RPLND) to NPC patients with RPLN recurrence to address the problem with open surgery. Materials and Methods: From March 2017 to October 2020, 10 NPC patients with RPLN recurrence underwent TORS‐RPLND using the da Vinci Si/Xi Surgical System. We applied the balloon occlusion test to protect the internal carotid artery, induction chemotherapy to shrink large tumors preoperatively, and ultrasound positioning to effectively locate unrecognizable RPLNs during surgery. Clinical characteristics, complications, and survival outcome data were retrospectively collected. Results: Of 10 patients, 8 underwent en bloc resection via TORS‐RPLND, and the remaining 2 patients were converted to open surgery because we failed to identify the RPLN during TORS. After introducing intraoperative ultrasound positioning, no such failure occurred. The mean operative time and intraoperative blood loss were 297 ± 120 min and 40 ± 43 ml, respectively. All surgical margins were negative. TORS‐related complications were mild, and the most severe one was grade 3 dysphagia in one patient who underwent conversion to open surgery (10%). With a median follow‐up of 19 months, only 1 (10%) patient developed cervical recurrence. Conclusions: TORS‐RPLND is feasible, safe, and effective in the treatment of NPC patients with RPLN recurrence, especially with the help of intraoperative ultrasound positioning. Level of Evidence: 4 Laryngoscope, 131:E1895–E1902, 2021 [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]