Outcomes and complications of endoscopic approaches for malignancies of the paranasal sinuses and anterior skull base

Jeffrey D. Suh, Vijay R. Ramakrishnan, MJohn J. Chi, James N. Palmer, Alexander G Chiu

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objectives: Malignant tumors of the paranasal sinuses are traditionally approached by a variety of external incisions. Recent advances in endoscopic endonasal surgery have allowed for some of these tumors to be treated endoscopically. The purpose of this study was to assess the outcomes and complications of the endoscopic approach in a series of patients with paranasal sinus malignancies. Methods: A retrospective chart review was performed of patients with sinonasal or skull base malignancies treated with endoscopic or endoscopic-assisted resections at a tertiary care institution from 2002 to 2010. Patient data were collected on symptoms, tumor type, operative technique, and postoperative course. Baseline risk factors, overall and disease-free survival data, and surgical outcomes were compared between the two groups. Results: Of the total 49 patients, 36 (73%) underwent an endoscopic approach and 13 (27%) underwent endoscopic-assisted approaches. Sarcomas (9 cases) were the most common tumor type, followed by squamous cell carcinoma (8), adenocarcinoma (8), and melanoma (7). The mean follow-up time for all patients was 3.58 years (range, 1.1 to 8.8 years). Surgical complications were more frequent with open approaches than with endoscopic approaches (23.1% versus 5.6%; p = 0.11). Medical complications were significandy more common with open approaches (38.5% versus 8.3%; p = 0.02). The disease-specific mortality rate was 8% (4 of 49). The local tumor recurrence rate was 16% (8 of 49). The 3-year disease-free survival rates were 86.8% in the endoscopic group and 67.7% in the open group (p = 0.047); however, the patients in the endoscopic group had lower T stages (p = 0.0068) and lower ASA scores (p = 0.03). Conclusions: Endoscopic approaches to the sinuses and skull base have become progressively more sophisticated with advances in skull base reconstruction, advances in surgical technique, and improvements in technology. This study dem-onstrates the relative safety and utility of the endoscopic approach for sinonasal and skull base malignancies. In carefully selected patients, endoscopic approaches demonstrate survival rates comparable to those of traditional surgery, and fewer perioperative complications. With appropriate planning and careful surgical decision-making, endoscopic surgery shows promise as a minimally invasive alternative in the treatment of sinonasal malignancies.

Original languageEnglish (US)
Pages (from-to)54-59
Number of pages6
JournalAnnals of Otology, Rhinology and Laryngology
Volume122
Issue number1
StatePublished - Jan 2013

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Paranasal Sinuses
Skull Base
Neoplasms
Disease-Free Survival
Survival Rate
Tertiary Healthcare
Sarcoma
Squamous Cell Carcinoma
Melanoma
Decision Making
Adenocarcinoma
Technology
Safety
Recurrence
Mortality

Keywords

  • Complication
  • Craniofacial resection
  • Endoscopic skull base surgery
  • Outcome
  • Sinus tumor
  • Skull base surgery

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Outcomes and complications of endoscopic approaches for malignancies of the paranasal sinuses and anterior skull base. / Suh, Jeffrey D.; Ramakrishnan, Vijay R.; Chi, MJohn J.; Palmer, James N.; Chiu, Alexander G.

In: Annals of Otology, Rhinology and Laryngology, Vol. 122, No. 1, 01.2013, p. 54-59.

Research output: Contribution to journalArticle

Suh, Jeffrey D. ; Ramakrishnan, Vijay R. ; Chi, MJohn J. ; Palmer, James N. ; Chiu, Alexander G. / Outcomes and complications of endoscopic approaches for malignancies of the paranasal sinuses and anterior skull base. In: Annals of Otology, Rhinology and Laryngology. 2013 ; Vol. 122, No. 1. pp. 54-59.
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abstract = "Objectives: Malignant tumors of the paranasal sinuses are traditionally approached by a variety of external incisions. Recent advances in endoscopic endonasal surgery have allowed for some of these tumors to be treated endoscopically. The purpose of this study was to assess the outcomes and complications of the endoscopic approach in a series of patients with paranasal sinus malignancies. Methods: A retrospective chart review was performed of patients with sinonasal or skull base malignancies treated with endoscopic or endoscopic-assisted resections at a tertiary care institution from 2002 to 2010. Patient data were collected on symptoms, tumor type, operative technique, and postoperative course. Baseline risk factors, overall and disease-free survival data, and surgical outcomes were compared between the two groups. Results: Of the total 49 patients, 36 (73{\%}) underwent an endoscopic approach and 13 (27{\%}) underwent endoscopic-assisted approaches. Sarcomas (9 cases) were the most common tumor type, followed by squamous cell carcinoma (8), adenocarcinoma (8), and melanoma (7). The mean follow-up time for all patients was 3.58 years (range, 1.1 to 8.8 years). Surgical complications were more frequent with open approaches than with endoscopic approaches (23.1{\%} versus 5.6{\%}; p = 0.11). Medical complications were significandy more common with open approaches (38.5{\%} versus 8.3{\%}; p = 0.02). The disease-specific mortality rate was 8{\%} (4 of 49). The local tumor recurrence rate was 16{\%} (8 of 49). The 3-year disease-free survival rates were 86.8{\%} in the endoscopic group and 67.7{\%} in the open group (p = 0.047); however, the patients in the endoscopic group had lower T stages (p = 0.0068) and lower ASA scores (p = 0.03). Conclusions: Endoscopic approaches to the sinuses and skull base have become progressively more sophisticated with advances in skull base reconstruction, advances in surgical technique, and improvements in technology. This study dem-onstrates the relative safety and utility of the endoscopic approach for sinonasal and skull base malignancies. In carefully selected patients, endoscopic approaches demonstrate survival rates comparable to those of traditional surgery, and fewer perioperative complications. With appropriate planning and careful surgical decision-making, endoscopic surgery shows promise as a minimally invasive alternative in the treatment of sinonasal malignancies.",
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AU - Suh, Jeffrey D.

AU - Ramakrishnan, Vijay R.

AU - Chi, MJohn J.

AU - Palmer, James N.

AU - Chiu, Alexander G

PY - 2013/1

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N2 - Objectives: Malignant tumors of the paranasal sinuses are traditionally approached by a variety of external incisions. Recent advances in endoscopic endonasal surgery have allowed for some of these tumors to be treated endoscopically. The purpose of this study was to assess the outcomes and complications of the endoscopic approach in a series of patients with paranasal sinus malignancies. Methods: A retrospective chart review was performed of patients with sinonasal or skull base malignancies treated with endoscopic or endoscopic-assisted resections at a tertiary care institution from 2002 to 2010. Patient data were collected on symptoms, tumor type, operative technique, and postoperative course. Baseline risk factors, overall and disease-free survival data, and surgical outcomes were compared between the two groups. Results: Of the total 49 patients, 36 (73%) underwent an endoscopic approach and 13 (27%) underwent endoscopic-assisted approaches. Sarcomas (9 cases) were the most common tumor type, followed by squamous cell carcinoma (8), adenocarcinoma (8), and melanoma (7). The mean follow-up time for all patients was 3.58 years (range, 1.1 to 8.8 years). Surgical complications were more frequent with open approaches than with endoscopic approaches (23.1% versus 5.6%; p = 0.11). Medical complications were significandy more common with open approaches (38.5% versus 8.3%; p = 0.02). The disease-specific mortality rate was 8% (4 of 49). The local tumor recurrence rate was 16% (8 of 49). The 3-year disease-free survival rates were 86.8% in the endoscopic group and 67.7% in the open group (p = 0.047); however, the patients in the endoscopic group had lower T stages (p = 0.0068) and lower ASA scores (p = 0.03). Conclusions: Endoscopic approaches to the sinuses and skull base have become progressively more sophisticated with advances in skull base reconstruction, advances in surgical technique, and improvements in technology. This study dem-onstrates the relative safety and utility of the endoscopic approach for sinonasal and skull base malignancies. In carefully selected patients, endoscopic approaches demonstrate survival rates comparable to those of traditional surgery, and fewer perioperative complications. With appropriate planning and careful surgical decision-making, endoscopic surgery shows promise as a minimally invasive alternative in the treatment of sinonasal malignancies.

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