Surgical salvage of recurrent nasopharyngeal cancer: An update

Abstract

Nasopharyngeal carcinoma is a unique tumor, which is endemic in Southern China, including Hong Kong. The management of locally recurrent tumors has been challenging, because of the anatomy and the effects of recent radical radiotherapy. Over the past few decades, various surgical approaches to the region have been investigated, aiming at providing a wide access to the nasopharynx without causing unnecessary trauma to the normal surrounding structures. Improving the understanding of skull base anatomy and the biological characteristics of the tumor, as well as advances in instruments and techniques, allows surgical salvage of early recurrent tumors using the minimally invasive procedures, such as the endoscopic endonasal approach and the transoral robotic surgical approach. For locally advanced tumors, however, the maxillary swing operation provides wide access to the bilateral nasopharynx and the ipsilateral parapharyngeal space, allowing resection of large tumors with adequate margins. Irrespective of the approach employed, every effort should be made to ensure microscopic clearance of disease, as the resection margins status is one of the most important independent prognostic factors influencing the local tumor control and overall survival, as shown by multivariate analysis. On the other hand, it is important to recognize the potential side effects and complications of surgery and work towards minimizing the potential post-operative complications that may in turn adversely affect the subsequent quality of life.