Salvage surgery for neck recurrence or residue of nasopharyngeal carcinoma after primary radiotherapy / 中华耳鼻咽喉头颈外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the surgical procedures and prognosis for neck recurrence or residue of nasopharyngeal carcinoma(NPC) after primary radiotherapy.</p><p><b>METHODS</b>A total of 153 cases with neck recurrence or residue after radiotherapy in NPC who received salvage neck surgery between January 2001 and December 2011 were retrospectively analyzed. There were rN1 109 cases, rN2 17 cases and rN3 27 cases. Of them 17 cases received bilateral neck dissection(ND) simultaneously. The surgical procedures included the modified radical neck dissection (MRND) in 66 cases, radical neck dissection (RND) in 48 cases, selective neck dissection(SND) in 28 cases, enlarged radical neck dissection (ERND) in 16 cases, local excision in 9 cases, and parotidectomy in 3 cases. The Kaplan-Meier method was used to calculate survival curves, and the differences between groups were calculated by χ(2) tests.</p><p><b>RESULTS</b>There were 20 cases (13.1%) with lymph node(LN) metastasis in level I and 7 cases (4.6%) with parotid gland LN metastasis. The 3-year and 5-year overall survival rates were 57.2% and 40.6% respectively, and the median survival time was 49 months. Cox regression analysis revealed that rN staging, size of LN and age were the main prognosis factors for survival.</p><p><b>CONCLUSIONS</b>Salvage surgery was effective for neck recurrence or residue of NPC after primary treatment, and MRND and SND are reasonable options so as to improve functionality. Dissection of LN in level I and parotid gland should be selective. Patients with stage rN3 or LN > 6 cm or age > 50 years had poor prognosis.</p>