2018 Section 5 - Rhinology and Allergic Disorders

Reprinted by permission of Eur Arch Otorhinolaryngol. 2016; 273(12):4343-4350.

Eur Arch Otorhinolaryngol (2016) 273:4343–4350 DOI 10.1007/s00405-016-4181-4

RHINOLOGY

Comparison of endoscopic and external resections for sinonasal instestinal-type adenocarcinoma

Geoffrey Mortuaire 1,2,4 Dominique Chevalier 1,2

• Xavier Leroy 2,3

• Claire Vandenhende-Szymanski 1 •

• Anne-Sophie Thisse 1

Received: 11 February 2015 / Accepted: 25 June 2016 / Published online: 30 June 2016 Springer-Verlag Berlin Heidelberg 2016

Abstract Endoscopic sinus surgery (ESS) is considered as a valid option in the management of nasal adenocarcinoma (ADC). Comparative studies with open approaches are still required. A monocentric retrospective study was carried out from May 2002 to December 2013, including 43 patients with intestinal-type adenocarcinoma of the eth- moid sinus. Non-resectable tumours or recurrences were excluded. Before 2008, open approach with lateral rhino- tomy (LR) was performed as the gold standard of treat- ment. From 2008, ESS was systematically used as a first- line option as long as a complete resection was achievable. Adjuvant radiation therapy was delivered (RT) for all the patients. LR and ESS were performed in, respectively, 23 and 20 patients. The two groups were comparable in terms of age, occupational dust exposure, histopathological sub- types, and T stage based on the pathological assessment of the specimen (10 pT2, 26 pT3, 2 pT4a, and 5 pT4b). The tumour origin was mainly located in the olfactory cleft with the involvement of the cribriform plate in 60 % of patients. No major complication was observed in ESS group with a reduced hospital stay (5.6 vs 7.6 days). The disease-free survival was not different between LR and ESS groups over a mean follow-up period of 6.6 years. Even for local advanced stages with skull base involvement, we confirm the reliability and the advantages of ESS in terms of

oncological outcomes and morbidity. We advocate com- plete excision of the olfactory cleft to ensure an appropriate control of the tumoral origin.

Keywords Adenocarcinoma Ethmoid Olfactory cleft Endoscopic surgery Radiotherapy

Introduction

Sinonasal malignant tumours account for 3 % of the head and neck cancers [ 1 ]. Adenocarcinoma (ADC) is the most frequent lesion found in the ethmoid sinus, even though some geographic differences exist [ 2 ]. ADC is known to be associated with exposure to wood dust [ 3 ]. The World Health Organization (WHO) classification considers three categories of ADC: high- and low-grade adenocarcinoma of non-intestinal-type and intestinal-type adenocarcinoma (ITAC). Like other tumours of the paranasal sinuses, ethmoid ADC has a tendency to spread insidiously to an advanced stage before producing symptoms and signs leading to diagnosis. Based on endoscopic findings, Jankowski et al. demonstrated that ADC originates in the olfactory cleft pushing away the surrounding anatomic structures before invading them [ 4 ]. With data collected from some Euro- pean countries, 3-year and 5-year global survival rates for ADC were, respectively, estimated to 58 and 46 % [ 5 ]. The treatment of ethmoid ADC is based on surgery, traditionally performed through a transfacial approach with or without anterior craniofacial resection. Surgery is often combined with adjuvant radiotherapy (RT). Since the late 1990s, endoscopic sinus surgery (ESS) has been proposed for excising malignant tumours [ 6 ]. However, the paucity of ADC, the varieties of histological subtypes, and the

& Geoffrey Mortuaire

geoffrey.mortuaire@chru-lille.fr

1 Otorhinolaryngology-Head and Neck Surgery Department, University Hospital, Lille, France

2

Universite´ de Lille 2, Lille, France

3 Pathology Department, University Hospital, Lille, France

4 Service d’ORL de chirurgie cervico-faciale, Hoˆpital Huriez CHRU Lille, Lille 59000, France

123

249