Outcomes and Complications of Locally Advanced Sinonasal Malignancies Treated with Open and Endoscopic Resections

Abstract

Objectives: (1) Compare outcomes of patients with sinonasal malignancies (SNM) treated with an open resection to patients treated with an exclusively endoscopic or endoscopic-assisted approach. (2) Analyze the differences in surgical complications, length of hospital stay, and margin status between open and endoscopic approaches. Methods: A retrospective review was performed on 102 patients with a pathologically diagnosed T3 or T4 SNM treated definitively at a tertiary care academic center from 1995 to 2012. Oncologic outcomes were determined. Results: Of the 102 patients, 29 presented with T3 disease while 73 presented with T4 disease. The most common histologic subtype was squamous cell carcinoma (56.9%). Fifty-three patients (52.0%) underwent open resection while 26 (25.5%) underwent an endoscopic or endoscopic-assisted resection. The 5- and 10-year disease-specific survival (DSS) for the 2 surgically treated groups was 67.6% and 65.2%, respectively. There was no significant difference between patients treated with open resection and patients treated with endoscopic resection in overall survival ( P = .98) or DSS ( P = .15). There was no significant difference between the groups with regard to length of stay (median for both = 5 days, P = .39) or margin status ( P = .42). The endoscopic surgery group had significantly more cerebrospinal fluid (CSF) leaks than the open surgery group (42% vs 6%, P < .001). Conclusions: Endoscopic and endoscopic-assisted resection of locally advanced SNM in the appropriately selected patient results in similar long-term oncologic control as open resection. There may be a higher rate of CSF leaks during endoscopic resections that contributes to hospital stays similar to those after open resections.