Abstract：
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).
CONCLUSIONS: 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.
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).
CONCLUSIONS: 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.
摘要：
目的：鼻内镜下鼻咽切除术（ENPG）与整块切除术在可切除的局部复发性鼻咽癌（rNPC）中已被广泛接受。但是对于大多数耳鼻咽喉头颈外科医生来说，这是一项很难掌握的技术。消融手术是一种新的、简化的肿瘤切除方法。我们设计了一种使用低温等离子射频消融（LPRA）的新方法，并评估了生存获益。
方法：对56例局部rNPC患者进行详细解释和回顾性分析。手术方法从切除边缘到肿瘤中心进行消融。转移后总生存期（OS），局部无复发生存率（LRFS），使用Kaplan-Meier方法分析无进展生存期(PFS)和无远处转移生存期(DMFS),并通过对数秩检验进行比较.
结果：所有手术均成功完成，术后无严重并发症或死亡。消融和获得NSFF的中位手术时间分别为29分钟(范围，15-100分钟)和101分钟(范围，30-180分钟）。术后平均住院天数为3天(范围，2-5天）。所有病例（100.0％）均进行了根治性消融，切缘阴性。54例（96.4％）患者的鼻咽缺损完全上皮化。截至数据截止日期（2023年9月3日），中位随访时间为44.3个月(范围，17.1-52.7个月，95%CI：40.4-48.2）。3年OS,LRFS,整个队列的PFS和DMFS为92.9％（95％CI：0.862-0.996），89.3%（95%CI：0.813-0.973），87.5%（95%CI：0.789-0.961），和92.9%（95%CI：0.862-0.996），分别。放疗周期是OS的独立危险因素(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），和DMFS(p=0.002；HR，34.776；95%CI：3.806-317.799）。
结论：使用低温等离子射频消融术的内镜下鼻咽切除术是一种新颖的，掌握和传播治疗可切除rNPC的安全简化方法。然而,需要更多的数据和更长的随访时间来证明其疗效.
方法：对56例局部rNPC患者进行详细解释和回顾性分析。手术方法从切除边缘到肿瘤中心进行消融。转移后总生存期（OS），局部无复发生存率（LRFS），使用Kaplan-Meier方法分析无进展生存期(PFS)和无远处转移生存期(DMFS),并通过对数秩检验进行比较.
结果：所有手术均成功完成，术后无严重并发症或死亡。消融和获得NSFF的中位手术时间分别为29分钟(范围，15-100分钟)和101分钟(范围，30-180分钟）。术后平均住院天数为3天(范围，2-5天）。所有病例（100.0％）均进行了根治性消融，切缘阴性。54例（96.4％）患者的鼻咽缺损完全上皮化。截至数据截止日期（2023年9月3日），中位随访时间为44.3个月(范围，17.1-52.7个月，95%CI：40.4-48.2）。3年OS,LRFS,整个队列的PFS和DMFS为92.9％（95％CI：0.862-0.996），89.3%（95%CI：0.813-0.973），87.5%（95%CI：0.789-0.961），和92.9%（95%CI：0.862-0.996），分别。放疗周期是OS的独立危险因素(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），和DMFS(p=0.002；HR，34.776；95%CI：3.806-317.799）。
结论：使用低温等离子射频消融术的内镜下鼻咽切除术是一种新颖的，掌握和传播治疗可切除rNPC的安全简化方法。然而,需要更多的数据和更长的随访时间来证明其疗效.
