Endoscopic Endonasal Nasopharyngectomy in Selected Cancers

• Published in: Otolaryngology-head and neck surgery Vol. 149; no. 3; pp. 424 - 430
• Main Authors: Castelnuovo, Paolo, Nicolai, Piero, Turri-Zanoni, Mario, Battaglia, Paolo, Bolzoni Villaret, Andrea, Gallo, Stefania, Bignami, Maurizio, Dallan, Iacopo
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-09-2013
• Subjects: Adult; carcinoma; Diagnostic Imaging; Endoscopy - methods; Female; Humans; Italy; Male; nasal cavity; Nasopharyngeal Neoplasms - surgery; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; oncology; Patient Selection; Pharyngectomy - methods; pharynx; Retrospective Studies; skull base; Survival Rate; Treatment Outcome; Italy; skull base; pharynx; carcinoma; oncology; nasal cavity
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599813493073

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).
Study Design
Case series with chart review.
Setting
Patients affected by NPTs who underwent NER from 1997 to 2011 at two Italian referral centers.
Subjects and 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.
Conclusion
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.