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. 2017 May 3:13:593-602.
doi: 10.2147/TCRM.S131185. eCollection 2017.

Minimally invasive endoscopic resection for the treatment of sinonasal malignancy: the outcomes and risk factors for recurrence

Ning He  1   2   3 , Xiaohong Chen  2 , Luo Zhang  2 , Xuejun Chen  2 , Zhigang Huang  2 , Qi Zhong  2 , Hongzhi Ma  2 , Ling Feng  2 , Lizhen Hou  2 , Jugao Fang  1   2   4
Affiliations

Minimally invasive endoscopic resection for the treatment of sinonasal malignancy: the outcomes and risk factors for recurrence

Ning He et al. Ther Clin Risk Manag. .

Abstract

Purpose: The role of minimally invasive endoscopic resection (MIER) in the treatment of sinonasal malignancy is controversial. Herein, we performed a retrospective review of a large case series of sinonasal malignancy patients treated with MIER aimed at evaluating the outcomes and identifying the risk factors for recurrence.

Methods: Patients with sinonasal malignancy who underwent MIER from March 2000 to May 2015 were enrolled, and their clinical data were collected. The clinical outcomes were evaluated by determining the 5-year overall survival (OS) and disease-free survival (DFS). The predictive factors for survival and potential independent risk factors for recurrence were explored.

Results: A total of 120 patients were enrolled, including 62 males and 58 females. The mean follow-up period was 51.4 (95% confidence interval: 44.0-59.1) months. The most frequent histological type was mucosal malignant melanoma. The positive margin rate was 19.2% (23/120). Seventy-one patients had the safety anatomic plane (SAP). Age ≥50 years, nodal metastasis, and not having the SAP were found to be predictive factors for survival, and absence of SAP was found to be an independent risk factor for recurrence.

Conclusion: Our study indicated that MIER is an effective and safe surgical procedure in appropriately selected patients. Tumor resection with a safety anatomic boundary is likely to lead to improved survival and decreased recurrence. However, a larger sample and long-term prospective observation are still required to establish the role of MIER in treatment of sinonasal malignancy.

Keywords: malignancy; minimally invasive endoscopic resection; outcome; recurrence; sinonasal skull base.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Intraoperative successive endoscopic images of an esthesioneuroblastoma case. Notes: (A) Resecting the base of tumor, (B) resecting the cribriform plate, (C) resecting the dura mater, (D) reconstructing the skull base defect with nasoseptal flap, and (E) fixing the nasoseptal flap with hemostasis material. a: middle turbinate of right side; b: olfactory cleft of right side; c: nasal septum; d: tumor; e: lateral wall of the right ethmoid sinus; f: cribriform plate; g: dura mater; h: lateral wall of the left ethmoid sinus; i: brain parenchyma; j: nasoseptal flap; k: hemostasis material.
Figure 2
Figure 2
Clinical outcomes in patients with sinonasal malignancy who received MIER. Notes: (A) Overall survival. (B) Disease-free survival. Abbreviation: MIER, minimally invasive endoscopic resection.
Figure 3
Figure 3
Clinical outcomes in the with-SAP and without-SAP groups. Notes: (A) Overall survival. (B) Disease-free survival. Abbreviation: SAP, safety anatomic plane.
Figure 4
Figure 4
Representative MRI scans of a patient with olfactory neuroblastoma. Notes: Preoperative (A) axial and (B) coronal T1-weighted MRI scans of olfactory neuroblastoma showing the tumor involving the left nasal cavity, ethmoid sinus, nasal septum, cribriform plate, and dura. The nasal septum, bilateral ethmoid sinus, cribriform plate, crista galli, olfactory bulb, and corresponding dura were resected, and a fascia flap and synthetic materials were used for reconstruction of the skull base intraoperatively. (C) Axial T2-weighted MRI and (D) coronal T1-weighted MRI scans captured 3 years after surgery and postoperative radiotherapy showing no tumor recurrence. Abbreviation: MRI, magnetic resonance imaging.
Figure 5
Figure 5
Representative imaging scans of a patient with right ethmoid sinus rhabdomyosarcoma. Notes: Coronal T1-weighted MRI and CT scans of tumor extent including (A) primary state, (B) after two cycles of preoperative chemotherapy, and (C) 1 year after surgery followed by postoperative chemoradiotherapy. Minimally invasive endoscopic surgery was conducted after two cycles of preoperative chemotherapy; the middle turbinate, ethmoid sinus, lamina papyracea, skull-base bone, and corresponding dura of the right side were resected intraoperatively. There was no local recurrence of the tumor after 1 year of follow-up. Abbreviation: MRI, magnetic resonance imaging.
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