Primary endoscopic nasopharyngectomy for nasopharyngeal carcinoma: systematic review & meta-analysis

A systematic review and meta-analysis for the use of primary endoscopic nasopharyngectomy (pENPG) alone in the treatment of primary nasopharyngeal carcinoma (pNPC). To evaluate its benefits and limitations compared to current standard therapy.

A literature search was conducted in January 2025 using PubMed, Embase, MEDLINE, and Cochrane databases. Studies were selected based on strict inclusion/exclusion criteria. Data was extracted on selection criteria for surgery, operation details, post-operative complications and treatment outcomes (survival outcomes and quality of life). Data was analysed using qualitative and quantitative methods and meta-analysis was performed as appropriate.

Four studies involving 164 patients who underwent pENPG were identified. All studies were retrospective in nature. Two studies analysed pENPG alone, whereas the other two studies compared pENPG to intensity-modulated radiotherapy (IMRT) or open surgery. 58% of patients who underwent pENPG had localised stage I NPC (T1N0M0). Three and five-year overall survival (OS) for pENPG-treated stage I NPC was 100% in two studies. Meta-analysis for all tumour stages yielded a pooled 5-year OS of 90.6% for pENPG (± chemoradiotherapy). One study compared pENPG vs. IMRT for stage I disease, with 5-year OS at 100% and 99.1% respectively. Radiotherapy-associated toxicities were significantly reduced with pENPG only. The severity of surgical complications correlated with the extent of resection.

pENPG utilisation is rare in current practice. It may be a feasible alternative to IMRT for early stage disease to minimise radiotherapy toxicities but prospective studies are necessary to evaluate this further.