Endoscopic vs Transfacial Removal of Sinusal Adenocarcinoma

Abstract

Objective: Compare the overall survival, recurrence-free survival, and complication rates between 2 comparable groups of patients operated by an endoscopic or a transfacial resection of a sinonasal adenocarcinoma. Method: A first group of 24 patients with a sinonasal adenocarcinoma recently operated endoscopically (« ENDO », 1999-2009) is compared to another group of 24 patients operated anteriorly by a transfacial approach (lateral rhinotomy “LR” 1993-2007). In this retrospective study, we included patients who would have had in 2010 an endoscopic resection. Results: Groups were comparable in terms of age and sex ( P = .49) and tumoral stages with 13T1-T2/11T3-T4 in the group ENDO and 12T1-T2/12T3-T4 in the group LR ( P = .77). a total of 43 out of 48 patients have had a postoperative radiation therapy. The mean follow-up was respectively of 27 and 82 months for the groups ENDO and LR. After 27 months, the overall survival curves were not significantly different. The recurrence-free rates were equally similar in both groups ( P = .71). The median duration of hospitalization was significantly shorter in the ENDO group (4 vs 8 days, P < .0001). The rate of early complications was strictly identical in both groups (3/24). Conclusion: The endoscopic approach is an effective treatment in selected cases of sinonasal adenocarcinomas. Early oncological outcome and morbidity are comparable to a transfacial approach. Hospitalization was significantly reduced and skin scars avoided. This procedure is less invasive but requires an optimal preoperative imaging protocol and an experienced surgical team.