Surgical Management Patterns of Sinonasal Malignancy: A Population-Based Study
28 May 2018
29 August 2018
25 October 2018 (online)
Objectives Determining surgical trends and outcomes for sinonasal tumors is challenging given their low incidence and heterogeneous pathology. This study utilized the National Cancer Database (NCDB) to identify trends and outcomes associated with surgical management of sinonasal tumors.
Design Retrospective database analysis.
Setting National Cancer Database.
Participants Patients with sinonasal malignancies identified from the NCDB between 2010 and 2015.
Main Outcome Measures The primary outcome was the choice of surgical therapy used for sinonasal tumor resection: endoscopic versus open approach. Each was cohort analyzed with respect to various demographic and clinicopathologic factors. A treatment effect model was used to identify potential differences between surgical approaches. Survival was evaluated using Kaplan–Meier analysis.
Results A total of 10,193 patients with sinonasal malignancies were identified in the NCDB database; of these, 2,292 had a documented subsite, histology, and definitive surgical treatment with documented surgical approach and were included in the analysis. About 71.9% of patients had an open approach and 28.1% a purely endoscopic procedures. Tumor histology, treatment facility type, margin status, and length of stay were all variables that were associated with significant differences between the open and endoscopic cohort. Five-year survival rates for the open and endoscopic cohorts were not significantly different (59.6 and 60.8%, respectively).
Conclusions Assessment of the NCDB revealed that 28% patients with sinonasal malignancy were selected for endoscopic surgery. These patients had comparable oncologic outcomes to open resection.
Presented at 2018 North American Skull Base Meeting Coronado, California.
All authors have approved the final manuscript and attest to the integrity of the original data and the analysis reported in the manuscript.
This research was supported by a National Institute of Health/ National Cancer Institute Cancer Center Support Grant, Grant number: P30 CA008748
- 1 Dutta R, Dubal PM, Svider PF, Liu JK, Baredes S, Eloy JA. Sinonasal malignancies: a population-based analysis of site-specific incidence and survival. Laryngoscope 2015; 125 (11) 2491-2497
- 2 Dulguerov P, Jacobsen MS, Allal AS, Lehmann W, Calcaterra T. Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer 2001; 92 (12) 3012-3029
- 3 Lund V, Howard DJ, Wei WI. Endoscopic resection of malignant tumors of the nose and sinuses. Am J Rhinol 2007; 21 (01) 89-94
- 4 Lund VJ, Wei WI. Endoscopic surgery for malignant sinonasal tumours: an eighteen year experience. Rhinology 2015; 53 (03) 204-211
- 5 Naunheim MR, Goyal N, Dedmon MM. , et al. An algorithm for surgical approach to the anterior skull base. J Neurol Surg B Skull Base 2016; 77 (04) 364-370
- 6 Mortuaire G, Leroy X, Vandenhende-Szymanski C, Chevalier D, Thisse AS. Comparison of endoscopic and external resections for sinonasal instestinal-type adenocarcinoma. Eur Arch Otorhinolaryngol 2016; 273 (12) 4343-4350
- 7 Devaiah AK, Andreoli MT. Treatment of esthesioneuroblastoma: a 16-year meta-analysis of 361 patients. Laryngoscope 2009; 119 (07) 1412-1416
- 8 Hanna E, DeMonte F, Ibrahim S, Roberts D, Levine N, Kupferman M. Endoscopic resection of sinonasal cancers with and without craniotomy: oncologic results. Arch Otolaryngol Head Neck Surg 2009; 135 (12) 1219-1224
- 9 Nicolai P, Battaglia P, Bignami M. , et al. Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience. Am J Rhinol 2008; 22 (03) 308-316
- 10 Swegal W, Koyfman S, Scharpf J. , et al. Endoscopic and open surgical approaches to locally advanced sinonasal melanoma: comparing the therapeutic benefits. JAMA Otolaryngol Head Neck Surg 2014; 140 (09) 840-845
- 11 Arnold A, Ziglinas P, Ochs K. , et al. Therapy options and long-term results of sinonasal malignancies. Oral Oncol 2012; 48 (10) 1031-1037
- 12 Chen MK. Minimally invasive endoscopic resection of sinonasal malignancies and skull base surgery. Acta Otolaryngol 2006; 126 (09) 981-986
- 13 Kim BJ, Kim DW, Kim SW. , et al. Endoscopic versus traditional craniofacial resection for patients with sinonasal tumors involving the anterior skull base. Clin Exp Otorhinolaryngol 2008; 1 (03) 148-153
- 14 Turner JH, Reh DD. Incidence and survival in patients with sinonasal cancer: a historical analysis of population-based data. Head Neck 2012; 34 (06) 877-885
- 15 Robin TP, Jones BL, Gordon OM. , et al. A comprehensive comparative analysis of treatment modalities for sinonasal malignancies. Cancer 2017; 123 (16) 3040-3049
- 16 Miglani A, Patel SH, Kosiorek HE, Hinni ML, Hayden RE, Lal D. Endoscopic resection of sinonasal mucosal melanoma has comparable outcomes to open approaches. Am J Rhinol Allergy 2017; 31 (03) 200-204
- 17 Sayed Z, Migliacci JC, Cracchiolo JR. , et al. Association of surgical approach and margin status with oncologic outcomes following gross total resection for sinonasal melanoma. JAMA Otolaryngol Head Neck Surg 2017; 143: 1220-1227
- 18 Cao W, Guan B, Yu A. , et al. Treatment and outcomes of endoscopic surgery and traditional open resection in sinonasal mucosal melanoma. Acta Otolaryngol 2017; 137 (08) 862-867
- 19 Hadad G, Bassagasteguy L, Carrau RL. , et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
- 20 Wellman BJ, Traynelis VC, McCulloch TM, Funk GF, Menezes AH, Hoffman HT. Midline anterior craniofacial approach for malignancy: results of en bloc versus piecemeal resections. Skull Base Surg 1999; 9 (01) 41-46
- 21 Ganly I, Patel SG, Singh B. , et al. Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study. Head Neck 2005; 27 (06) 445-451
- 22 Raza SM, Garzon-Muvdi T, Gallia GL, Tamargo RJ. Craniofacial resection of midline anterior skull base malignancies: a reassessment of outcomes in the modern era. World Neurosurg 2012; 78 (1-2): 128-136
- 23 Abergel A, Cavel O, Margalit N, Fliss DM, Gil Z. Comparison of quality of life after transnasal endoscopic vs open skull base tumor resection. Arch Otolaryngol Head Neck Surg 2012; 138 (02) 142-147
- 24 Castelnuovo P, Lepera D, Turri-Zanoni M. , et al. Quality of life following endoscopic endonasal resection of anterior skull base cancers. J Neurosurg 2013; 119 (06) 1401-1409