Nasopharyngeal endoscopic resection in the management of selected malignancies: ten-year experience* P. Castelnuovo 1 , I. Dallan 2 , M. Bignami 1 , P. Battaglia 1 , S. Mauri 1 , A. Bolzoni Villaret 3 , A. Bizzoni 3 , D. Tomenzoli 3 , P. Nicolai 3 1 Department of Otorhinolaryngology, University of Insubria, Varese, Italy 2 2 nd ENT Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy 3 Department of Otorhinolaryngology, University of Brescia, Brescia, Italy *Received for publication: April 29, 2009; accepted: September 22, 2009 DOI:10.4193/Rhin09.079 INTRODUCTION Endoscopic endonasal surgery is now considered the gold stan- dard in the management of most benign lesions of the sinonasal tract. In the last 10 years, this surgical approach has indeed emerged as a valid treatment option for selected malig- nant tumours (1-5) . The experience accumulated by many authors in this field, has naturally outlined the opportunity to manage also selected lesions of the nasopharynx (6-8) . It is well known that radiotherapy (RT) associated with chemotherapy (CHT) is the mainstay of treatment for nasopharyngeal carci- noma (NPC) (9) . The reasons for this are related to several aspects including the fact that most NPCs are undifferentiated or nonkeratinizing and consequently highly radiosensitive, and that the complexity of the nasopharyngeal anatomy with criti- cal areas (internal carotid artery, skull base, parapharyngeal space) in close proximity makes radical surgery challenging and associated with dismal results (10) . Moreover, lesions are frequently diagnosed at an advanced stage. External approach- es have been extensively described and codified (11-15) while only a few studies dealing with endoscopic techniques have been reported (6-8) . The improvement of the anatomical knowl- edge of this region, refinement of imaging techniques, and the surgical expertise acquired in sinonasal endoscopic surgery, has finally defined this approach feasible in selected cases. In the present study, we report our experience in the manage- ment of selected recurrent and previously untreated malignant nasopharyngeal lesions by nasopharyngeal endoscopic resec- tion (NER). The aim of the present study is to define the pre- cise indications for such an approach, to describe different endoscopic resections in relation to tumour extent, and to report our preliminary results in terms of complications, local control and determinate survival. Objective: To evaluate the feasibility of endoscopic surgery in the management of selected nasopharyngeal cancers. Three different types of nasopharyngeal endoscopic resections (NER) are described. Method of study: From January 1997 to October 2008, 17 consecutive patients (mean age: 50 years) with previously untreated (5) or recurrent nasopharyngeal tumours (12) were treated with curative intent by pure endoscopic resection. The extent of surgical resection was classified as follows: type 1 NER: resection limited to the postero-superior nasopharyngeal wall; type 2 NER: resection superiorly extended to the sphenoid sinus; type 3 NER: resection with lateral extension including the cartilaginous portion of the Eustachian tube and parapharyngeal space. Results: Type 1 NER was performed in 4 cases, type 2 in 6, and type 3 in 7. No intra- or post- operative complications were observed. Mean hospitalization time was 4 days (range: 1-7). Follow-up ranged from 10 to 138 months (mean: 41,2 ± 38). At the time of writing, 12 (71%) patients were free of disease, 3 (17%) alive with disease, and 2 (12%) dead of disease. Conclusions: NER is a feasible surgical technique that can be tailored in relation to tumour extension. Larger series and longer follow-up are needed to further validate the long-term results. Key words: endoscopic surgery, recurrence, nasopharynx, nasopharyngeal cancer, nasopharyn- gectomy SUMMARY ORIGINAL CONTRIBUTION Rhinology, 48, 84-89, 2010