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A 4-year review of surgical and oncological outcomes of endoscopic endonasal transpterygoid nasopharyngectomy in salvaging locally recurrent nasopharyngeal carcinoma

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To study the surgical and oncological outcomes of endoscopic endonasal transpterygoid nasopharyngectomy (EETN) in salvaging locally recurrent nasopharyngeal carcinoma (NPC).

Method

This was a retrospective clinical record review study carried out at a tertiary centre from June 2013 until May 2017. A total of 55 locally recurrent NPC patients (rT1–rT4) underwent EETN performed by single skull base surgeon with curative intention with postoperative adjuvant chemotherapy but without postoperative radiotherapy.

Results

There were 44 (80.0%) males and 11 (20.0%) females, with mean age of 52.5 years. The mean operating time was 180 min (range 150–280 min). 85% (47/55) of patients achieved en bloc tumour resection. 93% (51/55) of patients obtained negative microscopic margin based on postoperative histopathological evaluation. Intraoperatively, one (1.8%) patient had internal carotid artery injury which was successfully stented and had recovered fully without neurological deficit. There were no major postoperative complications reported. During a mean follow-up period of 18-month (range 12–48 months) postsurgery, five patients (9.1%) had residual or recurrence at the primary site. All five patients underwent re-surgery. One patient at rT3 passed away 6 months after re-surgery due to distant metastasis complicated with septicaemia. The 1-year local disease-free rate was 93% and the 1-year overall survival rate was 98%.

Conclusions

EETN is emerging treatment options for locally recurrent NPC, with relatively low morbidity and encouraging short-term outcome. Long-term outcome is yet to be determined with longer follow-up and bigger cohort study. However, a successful surgical outcome required a very experienced team and highly specialised equipment.

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References

  1. Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  Google Scholar 

  2. Zainal Ariffin (2011) IT Nor Saleha. NCR Report 2007, Ministry of Health, Malaysia

  3. Devi BCR, Pisani P, Tang TS, Parkin DM (2004) High incidence of nasopharyngeal carcinoma in native people of Sarawak. Borneo Island. Cancer Epi Bio Prev 13:482–485

    Google Scholar 

  4. Chan AT, Teo PM, Huang DP (2004) Pathogenesis and treatment of nasopharyngeal carcinoma. Semin Oncol 31:794–801

    Article  PubMed  Google Scholar 

  5. Suarez C, Rodrigo JP, Rinaldo A et al (2010) Current treatment options for recurrent nasopharyngeal cancer. Eur Arch Otorhinolaryngol 267:1811–1824

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ma J, Mai HQ, Hong MH et al (2001) Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma. J Clin Oncol 19:1350–1357

    Article  CAS  PubMed  Google Scholar 

  7. Lin JC, Liang WM, Jan JS et al (2004) Another way to estimate outcome of advanced nasopharyngeal carcinoma—is concurrent chemoradiotherapy adequate? Int J Radiat Oncol Biol Phys 60:156–164

    Article  PubMed  Google Scholar 

  8. You R, Zou X, Hua YJ, Han F, Li L, Zhao C, Hong MH, Chen MY (2015) Salvage endoscopic nasopharyngectomy is superior to intensity-modulated radiation therapy for local recurrence of selected T1–T3 nasopharyngeal carcinoma–A case-matched comparison. Radiother Oncol. 115(3):399–406

    Article  PubMed  Google Scholar 

  9. To EW, Lai EC, Cheng JH, Pang PC, Williams MD, Teo PM (2002) Nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 31 patients and prognostic factors. Laryngoscope. 112(10):1877–1882

    Article  PubMed  Google Scholar 

  10. Chang JTC, See LC, Liao CT et al (2000) Locally recurrent nasopharyngeal carci- noma. Radiother Oncol 54:135–142

    Article  CAS  PubMed  Google Scholar 

  11. King WW, Ku PK, Mok CO et al (2000) Nasopharyngectomy in the treatment of recurrent nasopharyngeal carcinoma : a 12-year experience. Head Neck. 22(3):215–222

    Article  CAS  PubMed  Google Scholar 

  12. Yoshizaki T, Wakisaka N, Murono S, Shimizu Y, Furukawa M (2005) Endoscopic nasopharyngectomy for patients with recurrent nasopharyngeal carcinoma at the primary site. Laryngoscope. 115(8):1517–1519

    Article  PubMed  Google Scholar 

  13. Emanuelli E, Albu S, Cazzador D, Pedruzzi B, Babighian G, Martini A (2014) Endoscopic surgery for recurrent undifferentiated nasopharyngeal carcinoma. J Craniofac Surg. 25(3):1003–1008

    Article  PubMed  Google Scholar 

  14. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  15. Benjamin E, Wong DK, Choa D (2004) ‘Moffett's’ solution: a review of the evidence and scientific basis for the topical preparation of the nose. Clin Otolaryngol Allied Sci. 29(6):582–587

    Article  CAS  PubMed  Google Scholar 

  16. Tang IP, Carrau RL, Otto BA, Prevedello DM, Kasemsiri P, Ditzel L, Muto J, Kapucu B, Kirsch C (2015) Technical nuances of commonly used vascularised flaps for skull base reconstruction. J Laryngol Otol. 129(08):752–761

    Article  CAS  PubMed  Google Scholar 

  17. Ridge JA (1993) Squamous cancer of the head and neck: surgical treatment for local and regional recurrence. Semin Oncol 20:419–429

    CAS  PubMed  Google Scholar 

  18. Al-Sheibani S, Zanation AM, Carrau RL, Prevedello DM, Prokopakis EP, McLaughlin N, Snyderman CH, Kassam AB (2011) Endoscopic endonasal transpterygoid nasopharyngectomy. Laryngoscope 121:2081–2089

    Article  PubMed  Google Scholar 

  19. Chen MY, Wen WP, Guo X et al (2009) Endoscopic nasopharyngectomy for locally recurrent nasopharyngeal carcinoma. Laryngoscope 119:516–522

    Article  PubMed  Google Scholar 

  20. Ko JY, Wang CP, Ting LL et al (2009) Endoscopic nasopharyngectomy with potassium-titanyl-phosphate (KTP) laser for early locally recurrent nasopharyngeal carcinoma. Head Neck 31:1309–1315

    Article  PubMed  Google Scholar 

  21. Chen MK, Lai JC, Chang CC et al (2007) Minimally invasive endoscopic nasopharyngectomy in the treatment of recurrent T1–2a nasopharyngeal carcinoma. Laryngoscope 117:894–896

    Article  PubMed  Google Scholar 

  22. Rohaizam J, Subramaniam SK, Vikneswaran T et al (2009) Endoscopic nasopharyngectomy: the Sarawak experience. Med J Malaysia 64:213–215

    CAS  PubMed  Google Scholar 

  23. Ho AS, Kaplan MJ, Fee WE Jr et al (2012) Targeted endoscopic salvage nasopharyngectomy for recurrent nasopharyngeal carcinoma. Int Forum Allergy Rhinol 2:166–173

    Article  PubMed  Google Scholar 

  24. Monteiro E, Witterick I (2014) Endoscopic nasopharyngectomy: patient selection and surgical execution. Oper Tech Otolaryngol. 25:284–288

    Article  Google Scholar 

  25. Chen MY, Wang SL, Zhu YL, Shen GP, Qiu F, Luo DH et al (2012) Use of a posterior pedicle nasal septum and floor mucoperiosteum flap to resurface the nasopharynx after endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma. Head Neck 34(10):1383–1388

    Article  PubMed  Google Scholar 

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Funding

This study was not funded.

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Authors and Affiliations

  1. Department of ORL-HNS, Sarawak General Hospital, Kuching, Sarawak, Malaysia

    Ing Ping Tang, Ling Xiu Ngui, Komathi Ramachandran & Li Yun Lim

  2. Department of ORL-HNS, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Jalan Datuk Mohd Musa, 94300, Kota Samarahan, Sarawak, Malaysia

    Ing Ping Tang

  3. Department of Oncology, Sarawak General Hospital, Kuching, Sarawak, Malaysia

    Pei Jye Voon & Kong Leong Yu

  4. Department of ORL-HNS, University of Malaya, Kuala Lumpur, Malaysia

    Prepageran Narayanan

  5. Department of ORL-HNS, Wexner Medical Centre, Ohio State University, Columbus, OH, USA

    Ricardo Carrau

Authors
  1. Ing Ping Tang
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  2. Ling Xiu Ngui
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  3. Komathi Ramachandran
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  4. Li Yun Lim
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  5. Pei Jye Voon
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  6. Kong Leong Yu
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  7. Prepageran Narayanan
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  8. Ricardo Carrau
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Corresponding author

Correspondence to Ing Ping Tang.

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Author and all the co-authors declare that all of them have no conflict of interest.

Ethical approval

All procedures performed in studies involved human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Tang, I.P., Ngui, L.X., Ramachandran, K. et al. A 4-year review of surgical and oncological outcomes of endoscopic endonasal transpterygoid nasopharyngectomy in salvaging locally recurrent nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 276, 2475–2482 (2019). https://doi.org/10.1007/s00405-019-05522-5

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  • DOI: https://doi.org/10.1007/s00405-019-05522-5

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