A novel procedure for transoral resection for retropharyngeal lymph node metastasis in head and neck cancer recurrence

Abstract

Background

The challenge in surgical treatment for retro-pharyngeal lymph node (RPLN) metastasis is to safely and reliably reach the parapharyngeal space and ensure removal of lesions while preserving the surrounding vitally important structure. The transoral approach has the shortest reach to the lesion, but has a narrow field of view and a small working space. Although there have been some recent reports of transoral robotic surgery (TORS), we have performed transoral RPLN dissection using an endoscope that is extremely cost-effective and often used in otolaryngology. In this study, we report a technique and the usefulness of endoscopic video-assisted transoral dissection of RPLNs in head and neck cancer patients.

Methods

A case series of patients undergoing endoscopic video-assisted transoral RPLN dissection was conducted from April 2012 to March 2020. The surgical technique, local control and complications were examined.

Results

Six patients underwent transoral endoscopic video-assisted transoral dissection of RPLN. The pathology was squamous cell carcinoma (SCC) in 4 patients and papillary thyroid cancer (PTC) in two patients. No postoperative complication was observed. No local recurrence was seen.

Conclusion

Using an endoscope that otolaryngologists are accustomed to handling, endoscopic video-assisted transoral dissection of RPLN was performed safely and with a good field of view. The identification of the tumor localization by indocyanine green (ICG) fluorescence method was also effective. Compared to TORS, it costs less and is considered to be an effective technique that can be performed without the need for special equipment.