Endoscopic Versus Open Resection of Non‐Squamous Cell Carcinoma Sinonasal Malignancies

Abstract

Objective Non‐squamous cell carcinoma (non‐SCC) variants of sinonasal cancer are rare cancers which are optimally managed with complete surgical resection. This study aims to assess the impact of surgical approach on outcomes by comparison of cases managed with open versus endoscopic resection. Methods The National Cancer Database 2004–2015 datasets were queried for all cases of non‐SCC initially managed with definitive surgery. Patients were grouped according to surgical approach (endoscopic vs. open) and compared for patient, tumor, and treatment variables using chi‐squared analyses. Logistic regression was used to determine predictors of receiving endoscopic surgery. Subgroups were compared for survival using Cox regression and perioperative outcomes. Results Of the 1595 cases of non‐SCC sinonasal cancers managed with definitive surgery, 42.2% were treated endoscopically. Open and endoscopic groups differed significantly by stage, primary site, histology, facility type, margin status, and clinical stage. Logistic regression showed that increased income was a significant predictor of receiving endoscopic surgery whereas stage IV (odds ratio: 0.58, P = .017) reduced the odds of receiving endoscopic surgery. Open resection patients had longer mean length of stay (LOS) than those who underwent endoscopic resection (5.09 vs. 3.16 days, P < .001). On Cox regression, no difference in survival was observed between open and endoscopic patients (P = .534). Conclusions Patients with non‐SCC sinonasal cancer managed with endoscopic surgery had a decreased LOS and no significant difference in survival compared to patients undergoing open resection. Therefore, an endoscopic approach may be considered a viable alternative to open resection. Level of Evidence NA Laryngoscope, 130: 1872–1876, 2020

Surgical Management of Sinonasal Cancers: A Comprehensive Review

“…Different studies comparing the oncological results between the transfacial and endoscopic approaches have shown similar results in terms of survival [46,[50][51][52]. For example, the NCDB study by Povolotskiy et al, which included 1595 patients with non-squamous sinonasal carcinoma, found an overall survival of 65.2% in patients treated by endoscopy and 65.4% in patients treated externally (p = 0.59) [52]. It should be noted that the analysis of the literature was limited for a long time by the fact that the published studies were retrospective, with, in the first series, tumors of an earlier stage in the group of patients operated by endoscopic approach compared to those operated by external approach.…”

“…Endoscopic surgery, therefore, reduces this time, reducing the delay to 15 days between diagnosis and radiotherapy compared to craniectomy surgery, in a series of 168 patients matched on the National Cancer DataBase (NCDB) [49]. Different studies comparing the oncological results between the transfacial and endoscopic approaches have shown similar results in terms of survival [46,[50][51][52]. For example, the NCDB study by Povolotskiy et al, which included 1595 patients with non-squamous sinonasal carcinoma, found an overall survival of 65.2% in patients treated by endoscopy and 65.4% in patients treated externally (p = 0.59) [52].…”

Long-term Outcomes of Endoscopic Resection Versus Open Surgery for Locally Advanced Sinonasal Malignancies in Combination With Radiotherapy

“…Surgical margin status is regarded as an independent risk factor for recurrence and survival [20,27,28] . Some scholars have found that these two surgical groups are similar with regard to negative surgical margin rate, at approximately 70-80% [19,21,22,29,30] . Regretfully, the status of the surgical margin cannot be compared between the two surgical groups in our series because some patients in the open surgery group underwent preoperative radiotherapy, promoting a higher R0 resection rate [30,31] .…”

The Selective Role of Open and Endoscopic Approaches for Sinonasal Malignant Tumours

“…Some authors have conducted studies comparing open and endoscopic approaches [ 19 , 22 , 24 , 48 , 101 , 113 – 115 ]. Higgins et al [ 22 ] conducted a systematic review with a pooled-data analysis to compare outcomes of endoscopic vs. craniofacial resection of SNMT.…”