An Analysis of Endoscopic and Open Approaches to Sinonasal Malignancies in the National Cancer Database from 2010 to 2014

Background Determining surgical trends and outcomes for sinonasal malignancies has been difficult given the rarity of these tumors. As such, studies comparing open and endoscopic surgical approaches are lacking in both quantity and sample size.

Methods Patients with sinonasal malignancies in the NCDB diagnosed after 2010 were assessed for data regarding surgical approach. Tumor, patient, and institution-specific factors that contributed to selecting endoscopic surgery were examined. Secondary analysis included a multivariate Cox regression analysis.

Results There were 2,015 patients with confirmed sinonasal malignancies and available data for TNM stage, surgical approach, and adjuvant treatment. Of these, 563 underwent an endoscopic surgical approach. Compared with squamous cell carcinoma (SCC), adenocarcinoma (OR: 2.61, 95% CI: 1.79–3.94, p < 0.0001), adenoid cystic carcinoma (OR: 1.96, 95% CI: 1.26–3.03, p = 0.003), mucosal melanoma (OR: 2.27, 95% CI: 1.61–3.20, p < 0.0001), sarcomas (OR: 2.37, 95% CI: 1.28–4.39, p = 0.006), esthesioneuroblastoma (OR: 3.07, 95% CI: 2.17–4.36, p < 0.0001), and sinonasal undifferentiated carcinoma (OR: 2.10, 95% CI: 1.06–4.15, p = 0.033) were more likely to undergo an endoscopic surgical approach. Among sinonasal subsites, primary sphenoid (OR: 2.60, 95% CI: 1.12–6.06, p = 0.027) tumors were more likely to undergo an endoscopic surgical approach while maxillary (OR: 0.61, 95% CI: 0.45–0.82, p = 0.001) tumors were less likely to undergo an endoscopic approach compared with nasal cavity tumors. Only T4 tumors were less likely to undergo endoscopic surgery compared with T1 tumors (OR: 0.71, 95% CI: 0.52–0.96, p = 0.026). Lastly, positive margins were not more likely to occur with the endoscopic surgical approach (OR: 0.81, 95% CI: 0.61–1.07, p = 0.143).

Conclusion These data demonstrate surgical treatment trends for sinonasal malignancies in the United States. Compared with SCC, other sinonasal malignancies were more likely to undergo an endoscopic surgical approach. Positive margin rates were not different among endoscopic and open approaches.