Oncologically endoscopic nasopharyngectomy for T1/T2a and selected T2b/T3 nasopharyngeal malignancies with nasopharynx resurfaced with posterior pedicle nasal mucoperiosteum flap.

Abstract

5574 Background: Endonasal endoscopic surgery is a minimal invasive approach but through which it is difficult to achieve oncologocal resections of nasopharyngeal malignancies due to the small operating space. The wound is difficult to recover and causes a persistent headache after operation for recurrent nasopharyngeal carcinoma (rNPC) patients due to the prior radiation. We have developed new techniques of oncologically endoscopic nasopharyngectomy (OEN) with nasopharynx resurfaced by a pedicle nasal mucoperiosteum flap (PNMF). Methods: From September 2004 to December 2009, 73 patients with nasopharyngeal malignancies received OEN with en bloc resection of tumor and 0.5-1.0cm margins through bilateral nostrils, including 59 locally rNPC, 6 newly untreated NPC with small nasopharyngeal nodus, and 8 other pathological types malignancies such as sarcoma, adenocarcinomas, and etc. According to the clinical staging system of NPC (UICC 2002), 32, 7, 26, and 8 cases were classified as T1N0M0, T2aN0M0, T2bN0M0, and T3N0M0, respectively. The nasopharyngeal defect was reconstructed with posterior pedicle middle turbinate or nasal septum mucoperiosteum flap based on the middle turbinate or nasal septum artery, branches of the sphenopalatine artery. Results: Among the 73 OEPs, 70 cases achieved en bloc resections of the tumors with negative surgical margins and no post-operation radiotherapy followed. The wounds healed in 8∼f16 weeks (median: 10w) in 23 rNPC patients with PNMF resurfaced, but 14∼f36 weeks (median: 18w) in rest rNPC cases without repair. No severe complication was observed except that 1 cases suffered internal carotid rupture and cured by interventional therapy. With median 26 months follow-up (range: 1 to 64m), the 2-year overall survival rate, local relapse-free survival rate, and progression-free survival rate were 87.5%, 83.3%, and 80.9%, respectively. Conclusions: Appropriate OEN is a minimally invasive, safe, and effective surgical modality for nasopharyngeal malignancies, even some high-selected newly untreated NPC. The PNMF is helpful to recover the nasopharyngeal wound for rNPC patients. No significant financial relationships to disclose.