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

Objective: 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. Methods: 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. Results: 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. Conclusions: 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.