Combined robotic and endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma

Abstract

Background: We report a series of 5 patients, who had recurrent nasopharyngeal carcinoma resected, using a combined technique of transoral robotic surgery and transnasal endoscopic surgery.

Methods: The recurrent tumours were located near the roof of the nasopharynx or involved the floor of the sphenoid sinus. The inferior parts of the resections were, transorally performed with a da Vinci surgical robot, after splitting the soft palate to expose the nasopharynx. The superior part of the resection, including the removal of the anterior wall and floor of the sphenoid, was performed transnasally under endoscopic vision.

Results: The tumours were removed en bloc with the sphenoid sinus floor. Two patients had clear margin, 2 patients had close margin, and one patient had positive margin in the clivus bone. Operating times ranged from 223 to 414 minutes, with a median of 240 minutes. Follow up, ranged from 8 months to 32 months, with a median of 21 months. The patient who had positive margin, developed recurrence cancer 9 months after the operation. One patient with close margin, developed local recurrence 21 months after the operation. The other 3 patients were disease-free.

Conclusion: For a minimally invasive surgery in the resection of recurrent nasopharyngeal carcinoma, transnasal endoscopic surgery and transoral robotic surgery complement each other, thereby promoting improved resection.