Abstract
Nasopharyngeal carcinoma (NPC) is highly radiosensitive, and radiotherapy is recommended for newly diagnosed NPC. Because of the poor visual surgical field, narrow operating space, difficulty protecting the internal carotid artery (ICA) and poor wound healing, the development of NPC surgery has been severely limited. For recurrent NPC, some open surgical approaches, such as the maxillary swing, successfully solve the above major problems. However, these operations are traumatic and lead to many postoperative complications. With the development of minimally invasive surgery, two concepts, the “third-hand technique” and “dumpling making technique”, have been proposed, combining with the intraoperative navigation systems and multiple anatomical landmarks for identifying ICA. Endoscopic nasopharyngectomy (ENPG) can also break through the above restrictions and has become a first-line treatment for locally recurrent NPC. Moreover, a new surgical staging system for recurrent NPC was devised to aid clinicians in choosing the most suitable treatment for these patients. A current study on ENPG alone for newly diagnosed stage I NPC shows that the long-term survival outcomes after ENPG are similar to those after IMRT. ENPG was associated with low medical costs and satisfactory QOL and might be an alternative strategy for treating newly diagnosed localized stage I NPC patients who refuse radiotherapy.
Highlights
Nasopharyngeal carcinoma (NPC) has an obvious geographical pattern of incidence and is endemic in Southern China and Southeast Asia with an annual incidence of 10–40/100,000 [1]
According to surgical practices for recurrent NPC patients, Chen et al pioneered the specific definition of “resectable area” for Endoscopic nasopharyngectomy (ENPG) in 2009 to include rNPC with tumors confined to the following locations: 1) the nasopharyngeal cavity; 2) the postnaris or nasal septum; 3) the superficial parapharyngeal space; or 4) the base wall of the sphenoid sinus (T3); in contrast, all rT4 diseases were unresectable by ENPG according to the 2002 clinical staging system of the UICC/ AJCC
The results indicated that ENPG was associated with a relatively good 5-year Overall Survival (OS) rate (77.1% vs. 55.5%, P = 0.003), QOL conservation, and significant reduction in post-treatment complications (12.5% vs. 65.3%, P < 0.001) and medical costs compared with Intensity-modulated radiotherapy (IMRT)
Summary
Nasopharyngeal carcinoma (NPC) has an obvious geographical pattern of incidence and is endemic in Southern China and Southeast Asia with an annual incidence of 10–40/100,000 [1]. The development of NPC surgery technology has faced three major problems: (1) the limited visual field and narrow operation space make it difficult to achieve radical resection; (2) recognition of the ICA is not easy, and the consequences of accidental injury are serious; and (3) the postoperative nasopharyngeal incision heals poorly, which affects patient quality of life.
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