Surgical Treatment of Esthesioneuroblastoma: Major Complication Rates, Progression Free and Overall Survival

Objective: Compare major complication rates in patients undergoing open versus endoscopic resection of esthesioneuroblastoma (ENB). Describe progression free (PFS) and overall survival (OS) in patients undergoing surgical resection of ENB. Identify prognostic utility of Kadish staging system with respect to PFS and OS.

Methods: Retrospective review of a single tertiary care University Hospital experience treating ENB from 1987 to 2014. 42 patients were included in the study. Those who had undergone prior treatment at another institution, or that had had incomplete documentation of treatment and postoperative course were excluded. Kadish stage at time of surgery was determined based on operative report and pathology report. Major complications were defined as: cerebrospinal fluid leak, meningitis, osteomyelitis, tracheostomy, and severe neurologic injury.

Results: Of the 42 patients in the study, 30 (71%) were male and 12 (29%) were female. Mean age was 48 years (range 20–76). Mean follow up was 7.8 years (range 0.08–25 years). One patient (2%) was Kadish stage A, 20 (48%) were Kadish stage B, 20 (48%) were Kadish stage C, 1 (2%) was Kadish stage D. Open approach was used in 33 (78%) cases, endoscopic approach was used in 7 (17%), and a combined approach was used in 2 (5%) cases. Rate of major complications was 16.7% and was not significantly different in the open versus endoscopic groups. 17 (40%) patients developed recurrence, 6 (16%) of which developed CNS dissemination. Progression free survival at 5, 10, and 15 years was 51%, 31%, and 31%, respectively. Overall survival at 5, 10, and 15 years was 88%, 78%, and 78%, respectively. There was no significant difference in PFS of Kadish B and C patients (log-rank p = 0.362). Overall survival was 100% for Kadish B patients, which was significantly different from Kadish C patients with 83%, 64%, and 64% OS at 5, 10, and 15 years, respectively (log-rank p = 0.014).

Conclusions: There was no difference in major complications after open versus endoscopic resection of ENB. Between 5 and 10 years of follow up there was a 20% decrease in PFS, highlighting the importance of long term follow up of these patients. While the Kadish staging system provided prognostic information regarding OS, no significant difference in PFS was observed between Kadish B and C. Further research is needed to determine if a different staging system would better predict progression free survival.