Clinical experience in Endoscopic Endonasal Transpterygoid Nasopharyngectomy (EETN) in local residual or recurrent nasopharyngeal carcinoma

Tang, Ing Ping (2021) Clinical experience in Endoscopic Endonasal Transpterygoid Nasopharyngectomy (EETN) in local residual or recurrent nasopharyngeal carcinoma. Medical Journal of Malaysia, 76 (1). p. 11. ISSN 0300-5283

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Abstract

Introduction: Endoscopic endonasal transpterygoid nasopharyngectomy (EETN) has emerged as a viable treatment option for local residual or recurrent NPC. Multidisciplinary discussion is needed to determine patient’s eligibility for EETN. The factors that exclude patients from EETN surgery include extensive involvement of parapharyngeal space, internal carotid artery, cavernous sinus with multiple cranial nerve palsies, extension into brain parenchymal and presence of distant metastasis. The surgery is purely via endoscope with four hands technique. Adequate sinonasal corridor with extended medial maxillectomy and posterior septectomy is crucial to have panoramic view of the field of surgery. Methods: A retrospective clinical record review was carried out for EETN cases done in Sarawak General Hospital from June 2013 till May 2017. Results: A total of 55 locally recurrent NPC patients (rT1–rT4) underwent EETN with curative intent performed by single skull base surgeon, with postoperative adjuvant chemotherapy but without postoperative radiotherapy. There were no major postoperative complications. During a mean follow-up period of 18-month post-surgery, five patients (9.1%) had residual disease 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%. Conclusion: EETN is an emerging treatment option for locally recurrent NPC, with relatively low morbidity and encouraging short-term outcome. However, successful surgical outcome requires an experienced team and highly sp

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