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Outcome of Patients Undergoing Salvage Surgery for Recurrent Nasopharyngeal Carcinoma: A Meta-analysis

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The common treatment of primary patients with nasopharyngeal carcinoma is chemotherapy and radiotherapy. Surgery is reserved as salvage procedure for recurrent or persistent disease. Nevertheless, information on the outcome of these patients and the role of adjuvant reirradiation treatment is scarce.

Methods

We conducted a meta-analysis to identify prognostic factors associated with outcomes of patients with recurrent nasopharyngeal carcinoma treated by salvage surgery.

Results

The study group consisted of 779 patients from 17 published studies who met the inclusion criteria. The primary tumor classification at recurrence was T1–2 in 83 % of patients and T3–4 in 16.6 %. Regional lymph node metastases were present in 88 patients. The 5-year overall survival and local recurrence-free survival rates of the entire cohort were 51.2 and 63.4 %, respectively, with a distant metastases rate of 11.3 %. The 5-year overall survival was 63 % in patients receiving surgery and adjuvant radiotherapy compared to 39 % in patients receiving surgery alone (P = 0.05). Independent predictors of outcome on multivariate analysis were sex, N classification, surgical approach (endoscopic vs. open), adjuvant treatment, and margin status. Both endoscopic surgery and reirradiation were independent predictors of improved survival.

Conclusions

More than half of the patients with recurrent disease can be salvaged by surgery. Margins status, and N and T classification are significant predictors of outcome. Multivariate analysis revealed that endoscopic surgery offers better outcome than open surgery for T3/4 disease in selected patients, and adjuvant reirradiation offers an additional survival advantage over surgery alone.

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Acknowledgment

We thank Cindy Cohen for her editorial assistance.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, The Technion, Haifa, Israel

    Shorook Na’ara MD, Moran Amit MD, MSc, Jacob T. Cohen MD & Ziv Gil MD, PhD

  2. The Oncology Institute, Rambam Health Care Campus, Haifa, Israel

    Salem Billan MD

  3. The Clinical Research Institute at Rambam, Rambam Health Care Campus, The Technion, Haifa, Israel

    Shorook Na’ara MD, Moran Amit MD, MSc, Jacob T. Cohen MD & Ziv Gil MD, PhD

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  1. Shorook Na’ara MD
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  2. Moran Amit MD, MSc
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  3. Salem Billan MD
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  4. Jacob T. Cohen MD
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  5. Ziv Gil MD, PhD
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Corresponding author

Correspondence to Ziv Gil MD, PhD.

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10434_2014_3683_MOESM1_ESM.tiff

Fig. 1 Flow chart of the study selection process. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement (TIFF 36 kb)

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Na’ara, S., Amit, M., Billan, S. et al. Outcome of Patients Undergoing Salvage Surgery for Recurrent Nasopharyngeal Carcinoma: A Meta-analysis. Ann Surg Oncol 21, 3056–3062 (2014). https://doi.org/10.1245/s10434-014-3683-9

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  • DOI: https://doi.org/10.1245/s10434-014-3683-9

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