2018 Section 5 - Rhinology and Allergic Disorders

Eur Arch Otorhinolaryngol (2016) 273:4343–4350

There was no difference between the two groups of patients ( p = 0.49) in terms of mucinous ITAC distribution (Table 1 ). Contrast-enhanced CT scan and MRI were used to set a clinical (cT) staging of the tumour extension. The results of the cT staging were compared with the pathological (pT) staging established after surgical resection on the histopathological assessment of the specimen. The mucosa surrounding the tumour site was harvested to set the margin status (Table 2 ). All the patients were cN0 and cM0 at diagnosis. Based on the histological findings, there were 10 pT2 (23 %), 26 pT3 (60 %), 2 pT4a (5 %), and 5 pT4b (12 %). The site of tumour origin was the olfactory cleft (superior turbinate, posterior and superior aspects of the

time and the specific-survival time were defined as the interval between the date of surgery and, respectively, the date of death or the date of death related to disease pro- gression or the last consultation for living patients.

Statistical analysis

Data were input into Microsoft Excel TM , and a statistical analysis was performed with the SPSS TM v 15.0 statistical software (SPSS Inc., Chicago, IL). Means and standard deviations were reported for descriptive statistics. The Fischer’s exact test was used the for comparison of demographic data. The non-parametric Mann–Whitney test was used to compare the means of non-paired samples. The survival analysis was conducted with the Kaplan–Meier test. The comparison between LR and ESS groups was performed with the Log-rank test. A two-tailed p value B 0.05 was considered statistically significant.

Table 1 Comparison of patients according to the surgical approach

Surgical approach

p value

LR

ESS

Population ( n = 43)

23

20

Results

Age

66.6 ( ? / - 9.8) 67.3 ( ? / - 8.1) 0.65*

Sex ratio

22H/1F

20H

NA

Population

Wood occupational exposure Poorly differentiated or mucinous ITAC pT stage (UICC 2012) pT2

21

17

0.65**

Forty-three patients (sex ratio: 42/1) with un-treated ITAC of the ethmoid sinus were referred to our institution from May 2002 to December 2013. Wood-dust occupational exposure was observed in 38 patients (88 %). Five patients did not report any specific exposure. Active tobacco use was noticed in six patients (14 %). Twenty-two patients (51 %) had never smoked. The clinical presentation was non-specific. The major symptoms were unilateral nasal obstruction (84 %), epistaxis (46.5 %), and nasal discharge (23 %). The mean delay to diagnosis was 7 months (from 1 to 48 months). During the first period of treatment, from May 2002 to September 2008, 23 patients with ITAC were treated through an external approach with LR. From September 2008 to December 2013, 20 patients were treated with ESS. The characteristics of the patients from LR and ESS groups were comparable in terms of demographic data and occu- pational exposure (Table 1 ). During our 12-year study, three T4b ITAC requiring exenteration and one T4a ITAC with skin extension were excluded from our study, as they could not have been treated with an endoscopic approach.

6

4

0.49**

5

5

0.98**

pT3

14

12

pT4a

1

1

pT4b

3

2

Hospital stay (days)

7 ( ? / - 1.3)

4.4 ( ? / - 1.5)

0.01*

Postoperative

2

–

NA

complications

ESS endoscopic sinus surgery, ITAC intestinal-type adenocarcinoma, LR lateral rhinotomy (external approach), NA not applicable * Mann–Whitney test, ** Fisher’s Exact test

Table 2 Correlation between cT and pT staging

pT staging

T2

T3

T4a

T4b

cT staging T1

1

1

–

–

T2

5

9

–

–

Tumour assessment and surgical management

T3

3

10

–

1

T4a

–

6

2

–

The biopsy analysis was performed in the preoperative workup. All the histological slides were reviewed by the same pathologist. ITAC were described as papillary or colonic in one hand and mucinous on the other hand. Mucinous ITAC were observed in ten patients (23 %).

T4b

1

–

–

4

Total

10

26

2

5

cT clinical staging based on CT scan and MRI assessment, pT pathological staging based on histological analysis of tumour specimen and margins

123

251