Anterior Skull Base Malignancies

Abstract

Introduction: Endonasal surgery of malignancies is still discussed controversially. To indicate the advantages and limitations of endonasal tumor surgery, the long-term survival data of 151 patients with sinonasal malignancies were compared according to the approach used for resection. Methods: Retrospectively, of the 151 sinonasal malignancies, 61 were removed purely endonasally using endoscopes and/or the microscope, whereas 90 tumors were resected via conventional external approaches. Demographic data, histopathology, extent of tumor involvement, and type of surgical approach were determined. Disease-specific survival and recurrence-free and metastasis-free survival were calculated using Kaplan-Meier analysis. Multivariate Cox proportional hazards regression models were used to identify independent prognostic markers. Results: Mean follow-up was 65 (range, 29 to 215; median, 64) months. During this time 51 patients died due to tumor disease, 36 from local recurrences and 15 because of metastatic spread. The 5-year disease-specific survival rate of the entire study cohort was 67%. In the group of patients whose lesions were removed endonasally, the 5-year disease-specific survival rate was 72% compared with 60% in the group of external tumor resection patients. Concerning the entire tumor group, pT stage, histological tumor type, type of disease, and status of surgical margins as well as infiltration of the orbit, brain, and/or sphenoid sinus have been shown to be of statistical significance for patient prognosis. Within the endonasal approach group, the type of disease and the status of surgical margins were statistically significant. Independent predictors of survival were pT stage, infiltration of the brain, and status of surgical margins, of which only the last was significant in the endonasal approach group. Conclusions: Our data show that endonasal surgery offers an effective treatment modality for sinonasal malignancies with insignificant morbidity yielding survival rates that are comparable with traditional external approaches.