New Classification of Endoscopic Transnasal Nasopharyngectomy for Recurrent Nasopharyngeal Carcinoma: Shanghai EENT Hospital’s Experience

Objective: Transnasal endoscopic nasopharyngectomy (TEN) has been an alternative treatment for recurrent nasopharyngeal carcinoma (rNPC). Current classification of the TEN needs updating. This study aims to establish new classification system of endoscopic endonasal nasopharyngectomy for rNPC.

Methods: A retrospective analysis was performed in 98 patients who underwent TEN for rNPC from January 2016 to November 2018 in our institution. Based on the stepwise exposed anatomic structures, the TEN was categorized into four types, which included type I (n = 41) with resection of the nasopharynx and sinus; type II (n = 12) with lateral extension to the parapharyngeal space; type III (n = 40) with lateral extension to the floor of the middle cranial fossa and infratemporal fossa, superior extension to orbital apex and cavernous, back to the prevertebral region; type IV (n = 5) with the resection of the involved internal carotid artery.

Results: The mean age was 51 years. There was no major complication. The median time of follow-up was 23 months. Ten patients were lost. Twenty-two patients reoccurred after surgery. Seventeen patients died. Among these patients, six patients died of massive bleeding, and four patients died of distant metastasis. The 2-year overall survival rate (OS) was 80.8%. The 2-year OS rates for rT1, rT2, rT3, and rT4 were 92.4, 100, 75.5, and 66.3%, respectively. The 3-year OS was 66.7%. The 2-year and 3-year local relapse-free survival (LRFS) rates were 56.2 and 43.2%, respectively. Two-year LRFS rates for rT1, rT2, rT3, and rT4 were 84.9, 38.9, 49.8, and 41.9%, respectively.

Conclusion: The four types of endoscopic endonasal nasopharyngectomy are effective in the surgical treatment of the rNPC. The preoperative evaluation and staged exposure of the ICA are reliable method, which will be an effective guideline for surgical treatment of the rNPC.