Establishment and development of minimally invasive surgery for nasopharyngeal carcinoma

Recurrent nasopharyngeal carcinoma (rNPC) is insensitive to radiotherapy, and re-irradiation lead to severe adverse reactions. Studies have confirmed that endoscopic nasopharyngectomy(ENPG) combined with vascularized nasal mucosal flap repair is superior to re-irradiation with intensity-modulated radiation therapy (IMRT) in terms of survival rate, quality of life and medical costs. This surgical approach has been widely recognized and shows advantages in early-stage rNPC, marking minimally invasive surgery (MIS) for rNPC as an important treatment option. However, the efficacy of surgery for patients with de novo early-stage nasopharyngeal carcinoma(NPC) and advanced rNPC remains controversial. With the standardization and popularization of surgical procedures for NPC, the improvement of surgical staging, the perioperative management of the internal carotid artery(ICA), the advancement of skull base defect repair technology, the implementation of reasonable postoperative treatment and follow-up, as well as the innovation of lymph node dissection technology, MIS for NPC will play an increasingly important role in the treatment of NPC. Evidence-based medical evidence have confirmed that MIS offers definite survival benefits and safety advantages rNPC, serving as the core treatment option for resectable rNPC. Meanwhile, its preliminary application in de novo early-stage NPC has demonstrated potential in avoiding radiotherapy-induced injuries, opening up a new direction for disease treatment. Nevertheless, the surgical treatment of NPC still requires more multi-center and clinical studies for further validation and improvement.