PMC7169354_01
(A) Retropharyngeal node metastasis involved the right internal carotid artery. (B) Bilateral neck metastases were found. (C) The right pyriform sinus and posterior wall were enhanced using a contrast agent.
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We considered the disease unresectable due to retropharyngeal lymph node metastasis with radiologically proven total encasement of the internal carotid artery (Figure 1).
Summary of treatment and monitoring of tumor response. (A) Various interventions received by the patient before salvage surgery. Arrows indicate the timing of each intervention. CBDCA indicates carboplatin; CDDP, cisplatin; PTX, paclitaxel. (B) Both primary and neck diseases disappeared at 11 weeks after concurrent chemoradiotherapy. (a) The retropharyngeal lymph node was not detected by positron emission tomography-computed tomography (CT). The CT scans showed recurrent disease at 24 weeks after concurrent chemoradiotherapy. (b) Arrows indicate the swollen retropharyngeal and paratracheal nodes. (c) Recurrent primary disease was detected after 13 courses of nivolumab therapy.
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Figure 2 shows a summary of the treatment and tumor response until the patient underwent salvage surgery.
(A, B) Some adhesions were found, although they did not differ greatly from those observed after chemoradiation therapy. (C) We performed free jejunal reconstruction. (D) We also performed additional caudal resection to maintain the surgical margin.
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There were no particular difficulties encountered during the surgery apart from some adhesions in certain parts as a consequence of previous oncological treatment (Figure 3).