Endoscopic Endonasal Nasopharyngectomy in Selected Cancers

Objective 1) To describe the different surgical techniques for nasopharyngeal endoscopic resection (NER) and 2) to support the efficacy of the endoscopic endonasal approach in the management of selected primary and locally recurrent nasopharyngeal tumors (NPTs). Method 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, transpterygoid approach to the postero‐lateral nasopharyx with removal of pterygoid plates and Eustachian tube, under control of parapharyngeal‐petrous‐cavernous segments of the internal carotid artery. Results From 1997 to 2011, 36 consecutive patients with primary (9 cases) or locally recurrent (27 cases) NPTs underwent an NER with curative intent. The lesions were staged (7th edition AJCC staging system) as follows: stage‐I, 16 (44.4%); stage‐II, 3 (8.3%); stage‐III, 13 (36.1%); and stage‐IVA, 4 (11.1%). 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 complications were observed. Postoperatively, 11 patients received intensity‐modulated radiation therapy, 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 safe, feasible, and minimally invasive surgical approach to manage selected primary and locally recurrent NPTs. Our preliminary outcomes are promising, with local control rates comparable to those of conventional open procedures. Larger case series and longer follow‐up are needed to validate the reproducibility and efficacy of the technique.