Abstract
The salvage treatment of locally recurrent nasopharyngeal carcinoma (NPC) is difficult due to the anatomical complexity of the nasopharynx including the proximity to critical organs. Accordingly, the treatment tends to be invasive whether the therapeutic option is re-irradiation or surgery. We report two cases of recurrent NPC treated with less-invasive transpalatal resection.
The first case was a 73-year-old female with rT1 adenoid cystic carcinoma diagnosed 21 months after chemoradiotherapy (CRT). The second case was a 54-year-old male with rT1 lymphoepithelial carcinoma diagnosed 24 months after CRT. Transpalatal resection was selected in both cases because the recurrent tumors were confined to the median position of the postero-superior wall in the nasopharynx. The lesions were exposed and resected easily via the transpalatal approach after the median incision of the soft palate. The visibility and maneuverability in the surgical field of the pharynx were good by endoscopic assistance and two-handed control including Rosenmuller's fossa and the posterior part of the vomer. There was no significant postoperative morbidity other than a small fistula in the second case. The first and second cases have been followed for 45 months and 20 months respectively after the salvage surgery with no evidence of local recurrence.
Endoscopic-assisted transpalatal resection is a simple, safe and less-invasive approach for the nasopharynx. Therefore, this technique is a practical treatment option for localized recurrent or residual NPC.
