Endoscopic nasopharyngectomy in nasopharyngeal carcinoma

Endoscopic sinus surgery offers a minimally invasive approach to reach the deep located nasopharynx, but the application of endoscopic nasopharyngectomy (ENPG) for locally recurrent nasopharyngeal carcinoma (NPC) has been limited by difficulties related to operating in the narrow nasal and nasopharyngeal cavities, achieving en bloc resection, protecting the internal carotid artery and reconstructing the defect. A series of innovations, such as the “third-hand technique,” “cube-like resection,” “dumpling-making technique,” and “pedicle nasal mucoperiosteal flap,” have been explored and applied to address these difficulties. Currently, ENPG accompanied with a nasal flap has been the most widely used modality for locally recurrent NPC with tumor limited in “resettable area,” and has led to better survival outcomes, better quality of life and lower treatment-related complication rates than salvage radiotherapy and traditional open surgery. Furthermore, ENPG has been extended to treat primary stage I NPC and postradiation nasopharyngeal necrosis, showing promising results in improving quality of life and survival.