title: Endoscopic endonasal nasopharyngectomy in selected cancers.
abstract: OBJECTIVE
  To describe the different surgical techniques for nasopharyngeal endoscopic resection (NER) and to support the efficacy of the endoscopic endonasal approach in the management of selected primary and locally recurrent nasopharyngeal tumors (NPTs).
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Patients affected by NPTs who underwent NER from 1997 to 2011 at two Italian referral centers.
  
  
  METHODS
  NER was tailored to the NPT extension and classified as follows: type 1 NER, resection of the posterior nasopharyngeal wall; type 2 NER, resection superiorly extended to the sphenoid; type 3 NER, trans-pterygoid approach to the postero-lateral nasopharynx with removal of pterygoid plates and Eustachian tube, under control of parapharyngeal-petrous-cavernous segments of the internal carotid artery.
  
  
  RESULTS
  Thirty-six consecutive patients with primary (9 cases) or locally recurrent (27 cases) NPTs were enrolled. The lesions were staged as follows: stage I, 16 (44.4%); stage II, 3 (8.4%); stage III, 15 (41.6%); and stage IVA, 2 (5.6%). Type 1 NER was performed in 6 cases, type 2 NER in 12, type 3 NER in 16, and bilateral-extended type 3 NER in 2. No perioperative mortality or major complications were observed. Postoperatively, 11 patients received intensity-modulated radiotherapy, with or without chemotherapy. Follow-up ranged from 2 to 173 months (mean: 38 months). Five years overall, disease-specific, and disease-free survivals were 75.1% ± 9.13%, 80.9% ± 7.79%, and 58.1% ± 14.8%, respectively.
  
  
  CONCLUSIONS
  NER is a feasible and minimally invasive surgical approach for the management of selected primary and locally recurrent NPTs. Our preliminary outcomes are promising, with local control rates comparable to those of conventional procedures. Larger case series and longer follow-up are needed to validate the reproducibility and efficacy of the technique.
authors.affiliation: Department of Otorhinolaryngology, University of Insubria, Varese, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Castelnuovo
authors.forename: Piero
authors.initials: P
authors.lastname: Nicolai
authors.forename: Mario
authors.initials: M
authors.lastname: Turri-Zanoni
authors.forename: Paolo
authors.initials: P
authors.lastname: Battaglia
authors.forename: Andrea
authors.initials: A
authors.lastname: Bolzoni Villaret
authors.forename: Stefania
authors.initials: S
authors.lastname: Gallo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bignami
authors.forename: Iacopo
authors.initials: I
authors.lastname: Dallan
mesh_terms: D000328:Adult; D003952:Diagnostic Imaging; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D009303:Nasopharyngeal Neoplasms / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009367:Neoplasm Staging; D018579:Patient Selection; D010611:Pharyngectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: carcinoma; nasal cavity; oncology; pharynx; skull base