Endoscopic Resection of Sinonasal and Skull Base Malignancies

Aim of the Study: This study aims to evaluate our experience with the endoscopic management of sinonasal and skull base malignancies and determine the oncologic outcomes of management of those patients.

Patients and Methods: We did a retrospective review of the electronic medical records of all patients who had endoscopic resection of their sinonasal cancer at MD Anderson Cancer Center (MDACC) as part of their treatment. The medical records were reviewed for patients’ demographics, disease characteristics, presenting symptoms, extent of the tumor, disease stage, histopathological findings and treatment details. The outcomes of interest included surgical complications and survival outcomes.

Results: Overall, 239 patients were included in the current study. Median age at the time of presentation was 54 years (range from 11.3 to 91 years). The median follow-up time was 46.6 months (range from 1 to 230 months). Of the 239 patients, 129 (54%) presented with previously untreated disease, 77 (32%) presented with persistent disease after partial treatment at another institution, and 33 (14%) presented with recurrent disease after prior treatment at another institution. The T stage of the primary tumor was distributed as follows: T1 in 41 (17%), T2 in 38 (16%), T3 in 65 (27%), and T4 in 95 (40%). Of those patients, 167 (70%) had a pure endonasal endoscopic approach, while 72 (30%) had endoscopic-assisted approach. The overall rate of surgical complications among our patients was 29% (69 patients). Postoperative cerebrospinal fluid (CSF) leakage occurred in 14 patients (6%). There was no significant difference in the rate of the intracranial complications between the purely endoscopic and endoscopic assisted group (p = 0.129). Negative surgical resection margins were achieved in 209 patients (87.4%). There was no significant difference in the surgical margin status between the pure endoscopic and endoscopic-assisted group (p = 0.682). The 5-year OS and DSS rates were 74 and 80%, respectively. There was no significant difference in OS and DSS between the purely endoscopic and endoscopic-assisted groups (p = 0.77 and 0.854, respectively). Overall survival and DSS were significantly worse in patients treated for recurrent disease than in those who presented with previously untreated disease or persistent disease (p = 0.001 and 0.002, respectively).

Conclusion: Our results add to the evolving experience of the efficacy of endoscopic approaches in management of sinonasal and skull base malignancies. Our data suggest that in properly selected patients and when performed by expert surgeons, endoscopic approaches have low morbidity and low complication rates and can provide an oncologically sound alternative to open approaches.

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