Recurrent nasopharyngeal carcinoma after salvage nasopharyngectomy

Abstract

Objective: To study the safety and oncological outcome of salvage surgery for local tumor recurrence after previous maxillary swing nasopharyngectomy. Setting: University hospital. Patients: Between 1998 and 2011, a total of 252 patients who had local tumor recurrence after previous nasopharyngectomy were recruited for the study.Main Outcome Measures: The locations of the recurrent tumor, operability, and surgical details of resection and reconstruction, as well as the complications and oncological results, were studied. Results: The local recurrence rate after nasopharyngectomy was 13.1%, the risk of which was significantly higher in patients with positive resection margins (39.6% vs 6.9%; P=.006). The chance of the development of local recurrence was significantly lower in patients who had received postoperative chemoradiation therapy than in patients who did not (29.4% vs 64.3%; P=.04). Overall, 63.6% of the patients with local recurrence were amenable to further surgery. Depending on the location of the tumor, remaxillary swing (n=10), contralateral maxillary swing (n=8), or central palatal resection (n=3)was performed. Free-flap coverage of the exposed skull base and the petrosal internal carotid artery was required in 12 patients. There was no evidence of hospital mortality or major complications associated with the surgery. The mean duration of follow-up was 22.4 months, and the overall disease-specific survival in the group of patients who underwent surgery was 80.9%. Conclusions: Surgical salvage for local tumor recurrence after previous nasopharyngectomy is safe, with a good oncological outcome. In the presence of previous maxillary swing surgery, reswing or contralateral swing operation is feasible, without major complications.