Endoscopic Nasopharyngectomy Indications and Outcomes: A 10-Year Single-Institution Experience

Introduction and Objectives: Endoscopic nasopharyngectomy (ENP) is a recently described surgical method that is increasingly favored over open approaches due to comparable outcomes and reduced morbidity for management of nasopharyngeal carcinoma (NPC). While the current literature has focused on its role in the treatment of recurrent NPC, especially in regions where NPC is endemic, its potential application extends to a wider range of pathologies. The aim of this study is to characterize the application and outcomes of ENP at a North American tertiary-care hospital over the past decade.

Methods: Retrospective review of all patients undergoing ENP for tumors in the nasopharynx at a single tertiary-care center between 2013 and 2023. Patients with extensive tumor centered elsewhere with extension to the nasopharynx were not included. All patients who underwent this surgery were included. Relevant data were collected via chart review.

Results: A total of fifteen patients underwent ENP during this period, with a mean age of 61.4 years (range: 18–87). Mean follow-up was 112.3 months (SD: 96.1). Tumor types included 7 (47%) recurrent nasopharyngeal carcinoma (NPC), 2 (13.2%) clear cell renal carcinoma, 1 (6.7%) recurrent adenoid cystic carcinoma, 1 (6.7%) p16+ squamous cell carcinoma, and 4 (26.4%) benign tumors (angiofibroma, angioleiomyoma, congenital choristoma, and recurrent pleomorphic adenoma). For 33% of subjects, this was a primary surgery, and 20% underwent simultaneous open transcervical exposure of the carotid artery. No major intraoperative complications were encountered. Wound closure techniques included a combination of nasoseptal flap (27%), other pedicled mucosal flap (20%), free mucosal graft (60%), buccal fat rotational flap (47%), and temporoparietal flap (7%). Nine patients had a history of prior nasopharyngeal radiation preoperatively and five received adjuvant radiation; four of these were re-irradiation. Postoperative osteoradionecrosis (ORN) developed in 5 (33%) patients. Of patients with ORN, 2 (40%) had reconstruction with a pedicled mucosal flap and the remaining 3 with a rotational buccal fat flap and free mucosal graft, all 3 of which underwent reirradiation. The single re-irradiated patient who did not develop ORN had a temporoparietal flap with a vascularized buccal fat pad flap. Long-term complications included eustachian tube dysfunction (47%), dysphagia (33%), velopharyngeal insufficiency (7%), and patulous eustachian tube (7%). There was no correlation of tumor type with complications. Tumor type of NPC was associated with salvage surgery (p = 0.005). Four patients had tumor recurrence after ENP, with 1 recurrent adenoid cystic carcinoma and the remaining recurrent NPC. 75% (N = 3) of recurrent tumors had positive margins on surgical pathology.

Conclusion: ENP is an increasingly utilized approach to tumors involving the nasopharynx. NPC is the most common indication for ENP; however, other indications include a variety of malignant and benign tumors. Common postoperative complications include dysphagia, eustachian tube dysfunction, and ORN in patients receiving high doses of radiation. The work-horse nasal septal flap is not always available as an option; thus, attention to improved vascularized closure techniques is necessary.

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Artikel online veröffentlicht:
05. Februar 2024