Technical Considerations in Sinonasal Tumor Recurrences

Abstract

Objective: 1) To study the rate of reoperations and recurrences of endoscopically treated benign and malignant sinonasal tumors. 2) To propose technical considerations in preventing reoperations and recurrences for endoscopically treated sinonasal tumors. Method: A retrospective review of all endoscopically treated benign and malignant sinonasal tumor pathologies from January 2002 to January 2012 was performed. Patient demographics, tumor characteristics, surgical approaches, and complications with a specific emphasis on reoperations and tumor recurrences were analyzed. Results: Sixty-four operative procedures were performed in 50 patients. Pathologies included 39 benign (21 IP, 5 JNA, 3 fibro-osseous lesions, 3 meningiomas, 2 lymphomas, 5 assorted lesions) and 11 malignant (2 esthesioneuroblastomas, 3 SCC, 2 olfactory carcinomas, 1 SNUC, 1 hemangiopericytoma, 1 NPC, and 1 ACC) tumors. Fourteen reoperations (21%) were performed secondary to tumor recurrence (9 cases) or residual tumor (5 cases). The majority of reoperations resulted from inadequate surgical exposure, incomplete adherence to oncological principles, excessive concern for functional preservation, and lack of a well-defined reproducible technique. Tumor biology played a key role in a small fraction of cases. Conclusion: Advances in endoscopic techniques, equipment, and experience have increased the number of sinonasal tumors being treated endoscopically. Wide surgical access, adherence to oncologic principles, and well-defined endoscopic techniques are paramount for successful treatment of these tumors. It is imperative that the endoscopic tumor surgeon balance oncologic principles with functional preservation.