Delayed postoperative bleeding associated with laryngopharyngeal necrosis following salvage endoscopic laryngopharyngeal surgery for recurrent adenoid cystic carcinoma of the tongue base after carbon ion radiotherapy: Case report

Carbon ion radiotherapy (CIRT) can deliver high-dose radiation to a tumor with minimum damage to normal tissue. Recently, transoral surgery (TOS) has become a treatment option for locoregional recurrence after radiotherapy for laryngopharyngeal carcinoma, aimed at preserving laryngeal function. A 67-year-old woman with crT2N0M0 adenoid cystic carcinoma of the tongue base, previously cured with CIRT, underwent salvage endoscopic laryngopharyngeal surgery at another hospital. One month after the surgery, she suffered massive pharyngeal bleeding and was transferred to our hospital for emergency hemostasis. We observed massive necrosis of the tongue base, extending to the epiglottic vallecula, and bleeding from the wound. Consequently, surgical debridement and cauterization were performed. Although wound healing took several months, laryngeal function was finally preserved. Careful postoperative observation is required when salvage TOS is performed in patients who previously underwent CIRT. The efficacy and safety of the procedure needs to be carefully evaluated in the future.

Automated summary

Carbon ion radiotherapy (CIRT) is effective in treating adenoid cystic carcinoma, but salvage transoral surgery (TOS) after CIRT requires careful postoperative observation due to potential complications. We report a case of massive pharyngeal bleeding after salvage TOS in a patient previously treated with CIRT, which was successfully managed with surgical debridement and cauterization. It highlights the importance of evaluating the efficacy and safety of salvage TOS in patients who have undergone CIRT in the future.