Endoscopic Transpterygoid Nasopharyngectomy for Nasopharyngeal Malignant Tumors

Background: The current treatment for most nasopharyngeal neoplasms is radiotherapy or radiochemotherapy. In some cases, such as adenoid cystic carcinomas and recurrent nasopharyngeal squamous carcinoma, primary or salvage surgery may play an important role. However, these surgeries are sometimes difficult to perform and the results vary according to tumor size, complexity of resection and status of surgical margins.

Objectives: The aim of this study was to describe the results of primary endoscopic transpterygoid nasopharyngectomy approach for adenoid cystic carcinomas or as a salvage procedure for recurrent nasopharyngeal squamous carcinoma.

Patients and Methods: From June 2007 to April 2013, twelve patients with nasopharyngeal malignant tumors were treated with surgical endoscopic approach at a single institution. This surgery was performed in patients with tumors not involving the internal carotid artery, soft palate, and without intracranial or clivus extension.

Results: Twelve patients underwent 13 surgeries. Histopathology types were recurrent carcinoma of the nasopharynx (7 patients, 8 surgeries) and adenoid cystic carcinoma (5 surgeries). Complete resection with negative microscopic margins was achieved in 11 of the 13 surgeries. In 2 patients with adenoid cystic carcinoma, the resection margins were positive. Both underwent postoperative radiotherapy. One remains disease free for 21 months and the second patient has symptomatic tumor after 19 months of follow-up. Among the 11 cases that had negative margins, there were four relapses: one at the contralateral nasopharynx, other in the soft palate and two patients in cavernous sinus. The patient with contralateral nasopharyngeal relapse was submitted to a second endoscopic salvage surgery and remains disease free for 65 months. The patient with palate recurrence underwent wide resection via midfacial degloving and remains disease free for 24 months. The 2 patients with recurrence in cavernous sinus are alive with symptomatic disease. There were no major intraoperative complications or mortality. There was one postoperative death due to internal carotid artery rupture on the 25th postoperative day. One patient had pharyngeal stenosis. Adjuvant radiotherapy was performed in 4 of 5 cases of adenoid cystic carcinoma. After a period of follow up from 5 to 75 months, there were one postoperative death, 2 patients with local persistent disease and 2 who underwent a second salvage surgery. Nine patients were without evidence of disease at last follow up.

Conclusion: Endoscopic transpterygoid nasopharyngectomy is feasible and may be a good option for the surgical treatment of selected patients with primary or recurrent nasopharynx malignant neoplasms without clivus, dura mater or intracranial invasion and not involving the internal carotid artery and soft palate.