Endoscopic nasopharyngectomy for locally recurrent nasopharyngeal carcinoma.
OBJECTIVE
Nasopharyngectomy is the primary treatment for locally recurrent nasopharyngeal carcinoma (rNPC). However, oncological nasopharyngectomy is difficult to achieve, even using extranasal surgical approaches, with potential risks of severe functional disabilities and serious complications. This report introduces an innovative, minimally invasive, oncological, endoscopic nasopharyngectomy.


METHODS
Between October 2004 and January 2008, 37 rNPC patients received endoscopic nasopharyngectomy, with 17, 4, 14, and 2 cases of rT1N0M0, rT2aN0M0, rT2bN0M0, and rT3N0M0, respectively. Tumors in all patients were confined to the nasopharyngeal cavity, postnaris, nasal septum, superficial parapharyngeal space, or the base of the sphenoid sinus. Nasopharyngeal malignancies and adequate surgical margin (>0.5-1.0 cm) were required for continuous en bloc resection.


RESULTS
Among the 37 endoscopic nasopharyngectomies, 35 achieved en bloc tumor resection with negative surgical margins. In the remaining two cases, the tumors were dissected into small blocks, and one had positive surgical margins. No patient received postoperative radiotherapy and no severe complication was observed. During the 6-45 months of follow-up (median, 24 months), five patients experienced in situ residual or recurrence with 1 submaxillary lymphatic metastasis. One patient developed distant metastases and died, one died of intracranial infection, and one died of another cancer. The 2-year overall survival rate, local relapse-free survival rate, and progression-free survival rate were 84.2%, 86.3%, and 82.6%, respectively.


CONCLUSIONS
Appropriate endoscopic nasopharyngectomy is a minimally invasive, safe, and promising surgical modality for the en bloc excision of rNPCs with encouraging short-term outcome. Long-term patient follow-up is ongoing.
Chen
Ming-Yuan
MY
State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
Wen
Wei-Ping
WP
Guo
Xiang
X
Yang
An-Kui
AK
Qian
Chao-Nan
CN
Hua
Yi-Jun
YJ
Wan
Xiang-Bo
XB
Guo
Zhu-Ming
ZM
Li
Tian-Ying
TY
Hong
Ming-Huang
MH
D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009666:Nose / Q000601:surgery*; D010611:Pharyngectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome