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ICAR SINONASAL TUMORS

TABLE X.1 Evidence surrounding open versus endoscopic approach for squamous cell carcinoma.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

EEA has similar oncologic outcomes for sinonasal IP-SCC to those observed with traditional open approaches No association between positive margins and surgical approach

Karligkiotis et al. 247

2016 3

Retrospective cohort

34 IP-SCC patients

1. 5-year OS 2. 5-year DSS 3. 5-year RFS

Torabi et al. 241

2020 4

Retrospective database (NCDB) Retrospective database (NCDB)

1329 SCC patients EEA( n = 216) Open ( n = 1113) 1483 SCC patients EEA( n = 353) Open ( n = 1130)

1. Positive margins 2. OS 1. OS 2. 30- and

Kilic et al. 135 1. EEA is comparable to open approaches, even accounting for confounding factors 2. EEA is associated with a shorter hospital LOS Abbreviations: DSS, disease-specific survival; EEA, endoscopic endonasal approach; IP, inverted papilloma; LOS, length of stay; OS, overall survival; RFS, recurrence-free survival; SCC, squamous cell carcinoma. 2017 4 90-mortality 3. LOS

demographics, disease characteristics, or treatment modal ities. The EEA overall had a shorter hospital LOS (3.8 vs. 7.0 days; p < 0.001) and a greater 5-year OS (81.9% vs. 75.6%; p = 0.03). After multivariate regression, there was a trend toward greater survival benefit from EEA, but this did not reach significance. Patients undergoing EEA were more likely Kadish stage C (45.9%), followed by stages A (32.2%), B (14.4%), and D (7.4%). Taken together, the current level 4 evidence indicates that EEA achieves com parable control rates and survival, along with decreased complication rates, compared to open approaches for ONBs. C Adenocarcinoma Meccariello et al. published a systematic review on 1826 patients comparing EEA versus open approach for sinonasal adenocarcinoma ( n = 431 EEA, n = 31 endoscopic-assisted, n = 1270 open). 259 They found a significantly shorter hospital LOS in the EEA group as compared to the endoscopic-assisted or open groups. The incidence of local failure was lower in the EEA group as compared to the open group (17.8% vs. 38.5%; p < 0.01).The EEA and endoscopic-assisted groups showed lower rates of major complications (6.6% EEA and 25.9% endoscopic assisted) as compared with the open group (36.4% open; p < 0.01). In a single-institutional retrospective study, Mor tuaire et al. compared open ( n = 23) to EEA ( n = 20) approaches for resection of ITAC of the ethmoid sinus. 260 The two groups were comparable in terms of age, occu pational dust exposure, histopathological subtypes, and pathologic T stage. No major complication was observed in the EEA group. DFS was not different between the open and EEA groups over a mean follow-up period of

6.6 years. The LOS was significantly less for the EEA ver sus the open approach (endoscopic 4.4 ± 1.5 days vs. open 7.0 ± 1.3days; p = 0.01). Local recurrences were observed in nine patients (five from the open group and four from the EEA group). Other individual retrospective cohort studies published similar findings showing comparable outcomes between EEA and open approaches for adenocarcinoma of the paranasal sinuses (Table X.3). 259–264 D Sinonasal sarcoma Limited data are available on the outcomes of open surgery versus EEA of sinonasal sarcomas (Table X.4). Gore et al. performed a systematic review of sinonasal sarcoma stud ies. They reported that 5-year OS was not statistically different between cohorts (68.5% EEA, n = 24; 100% endoscopic-assisted open, n = 3; 77.8% open, n = 57; p = 0.80). 265 Overall, the data suggest that open surgery and EEA have similar survival in sinonasal sarcoma, but additional large studies are needed to control for confounders. 265,266 E Sinonasal mucosal melanoma Sinonasal mucosal melanoma (SNMM) universally por tends a poor prognosis. Numerous studies have looked specifically at EEA for sinonasal SNMM, 267–279 of which most have been smaller cohort studies. Most show sim ilar outcomes between EEA and open approaches when adjusting for disease severity. It should be noted that advances in adjunctive oncologic treatments have prob ably influenced many of these outcomes in both sur gical approaches, as SNMM patients typically receive