The Short-term Effect Of Plasma-assisted Transnasal Endoscopic Nasopharyngectomy For Recurrent Nasopharyngeal Carcinoma

Objective:Preliminary discussion on the short-term effect of plasma-assisted transnasal endoscopic nasopharyngectomy for local recurrence and residual lesions of nasopharyngeal carcinoma after radiotherapy.Methods:The clinical data of 23 patients with local recurrence and residual nasopharyngeal carcinoma who were hospitalized in our hospital from August2017 to December 2020 and who underwent plasma-assisted endoscopic nasopharyngectomy were selected for analysis.Comparison of pre-operative and post-operative imaging,nasal endoscopic changes,surgical margins,surgical-related complications and other indicators,and preliminary analysis of postoperative survival rate of patients.Results:The average age of 23 patients was 46 years old.All these patients underwent nasopharyngeal carcinoma resection under nasal endosc-opy assisted by low temperature plasma system,and 4 patients underwent neck lymph node dissection at the same time.According to the 2017 eighth edition of the American Joint Committee on Cancer(AJCC),the lesions were staged as follows:r I,10;r II,5;r III,6 and r IVA,2.Pathological results:undifferentiated non-keratinizing carcinoma:16,differentiated non-keratinizing carcinoma:5,keratinizing carcinoma: 2.The median operative time was 102minutes(33-523 minutes),the median blood loss was 20 ml(5-300ml).The average postoperative hospital stay was 7 days.There were no serious complications during the operation in 23 patients,and no deaths occurred during the operation.Postoperative complications were mild,they mainly include headache 17.4%(4/23),blood in the tears 8.7%(2/23),nasopharyngeal necrosis8.7%(2/23),secretory otitis media 8.7%(2/23),Nasal adhesions were 4.3%(1/23).Tumor resection: Tumor resection: combined with the patient’s imaging changes and nasal endoscopy results before and after surgery,it was found that the tumors of 23 patients were completely removed.The positive rate of resection margin was 40.0%.The average follow-up period was 20 months(4 to42 months).During the follow-up,4 patients died,of which 2 died of unknown causes,1 died of cerebral infarction,and 1 died of multiple organ failure.One patient recurred and operated again in 10 months after the first operation,and developed lung metastasis 3 years after the first operation,and Survive with tumor thereafter.The 1-year,2-year,and 3-year overall survival rates were95.0%,78.4%,and 78.4%,respectively,and the local recurrence-free survival rate was 92.9%.Conclusion:Plasma-assisted endoscopic nasopharyngectomy for the treatment of local recurrence and residual lesions of nasopharyngeal carcinoma after radiotherapy is a safe and feasible surgical option,which has the advantages of intraoperative bleeding,less surgical complications,and short operation time.The short-term curative effect of this surgical method is good,but the sample size of this study is small,and the follow-up time is short.Its curative effect still needs to increase the sample size and prolong the follow-up time for verification.