Endoscopic Endonasal Surgery for Squamous Cell Carcinoma of the Sinonasal Cavities and Skull Base

Background: Over the last decade, the feasibility of endoscopic approaches for the management of sinonasal malignancies has been demonstrated. Studies reporting early oncologic outcomes, however, have been limited by short follow-up and heterogeneity of histopathology.

Methods: Patients treated at the University of Pittsburgh Medical Center for squamous cell carcinoma (SCC) of the sinonasal cavity and skull base with endoscopic techniques were retrospectively reviewed. Demographic, clinicopathologic, operative and perioperative, and oncologic outcomes were collected. Kaplan-Meier methods were used for survival analysis.

Results: Thirty-five patients (21 M, 14 F) with sinonasal SCCs with a mean age of 57 years (SD 13) were reviewed. Mean length of follow-up was 31 months, and mean hospital length of stay was 4.5 days. Nine patients (26%) were treated for recurrent disease. Twenty-six patients (74%) had strictly endoscopic procedures; of the nine remaining patients, three (9%) underwent frontal craniotomies, three (9%) had orbital exenterations, and three (9%) had transoral/transfacial maxillectomies in addition to the endoscopic approach. Eight patients (23%) experienced major complications. Twenty-seven patients underwent curative procedures, and eight underwent debulking procedures. Of those who underwent curative intent procedures, five (19%) had positive margins. Five-year local control for the cohort and for patients who underwent surgery for curative intent was 60% and 66%, respectively. Five-year overall survival for the entire group and for patients who underwent surgery for curative intent was 68% and 78%, respectively.

Conclusions: Endoscopic craniofacial resection for squamous cell carcinoma provides sound oncologic outcomes with acceptable complications compared with open approaches.