Nasopharyngeal Endoscopic Resection Extended to the Internal Carotid Artery (Type 4): Technical Notes, Indications, and Outcomes

Background: Endoscopic surgical approaches for nasopharyngeal malignancies, including recurrent nasopharyngeal carcinoma (rNPC) and nasopharyngeal salivary gland tumors (NSGT), have seen significant development over the last decades. Our groups have expanded the classification of nasopharyngeal endoscopic resections (NER) from type 1 to 3 to incorporate internal carotid artery (ICA)-including ablations. The aim of this work is to describe the surgical technique, indications, and preliminary oncological outcomes of NER extended to ICA, proposing it as type 4 NER. Methodology: Consecutive patients affected by nasopharyngeal malignancies and treated with NER type 4 were included. Data on patient-, disease-, and treatment-related factors were collected. Adverse events were classified from G1 to G5 according to the Common Terminology Criteria for Adverse Events. Preliminary survival outcomes were measured. A detailed description of the surgical steps of NER type 4 was reported. Results: A total of 13 patients were included: 7 NPC and 6 non-NPC, of which 4 were primary adenoid cystic carcinoma (ACC), 1 was recurrent ACC, and 1 was polymorphous adenocarcinoma. After a median follow-up of 34.7 months, 5 patients had a local recurrence during follow-up after a median of 17.3 months, one of which died at 10.3 months after surgery. The cumulative ≥ G3 adverse event rate was 61.5%. No major complications directly associated with ICA occlusion were reported. Conclusions: NER type 4 is a potential treatment alternative to (re)irradiation in highly selected patients with nasopharyngeal malignancies involving/abutting the ICA. The results reported should be considered preliminary; a novel description of the technique is provided.