Endoscopic Versus Open Resection of Non-Squamous Cell Carcinoma Sinonasal Malignancies

Non-squamous cell carcinoma (non-SCC) variants of sinonasal cancer are rare cancers which are optimally managed with complete surgical resection. This study aims to assess the impact of surgical approach on outcomes by comparison of cases managed with open versus endoscopic resection.

The National Cancer Database 2004-2015 datasets were queried for all cases of non-SCC initially managed with definitive surgery. Patients were grouped according to surgical approach (endoscopic vs. open) and compared for patient, tumor, and treatment variables using chi-squared analyses. Logistic regression was used to determine predictors of receiving endoscopic surgery. Subgroups were compared for survival using Cox regression and perioperative outcomes.

Of the 1595 cases of non-SCC sinonasal cancers managed with definitive surgery, 42.2% were treated endoscopically. Open and endoscopic groups differed significantly by stage, primary site, histology, facility type, margin status, and clinical stage. Logistic regression showed that increased income was a significant predictor of receiving endoscopic surgery whereas stage IV (odds ratio: 0.58, P = .017) reduced the odds of receiving endoscopic surgery. Open resection patients had longer mean length of stay (LOS) than those who underwent endoscopic resection (5.09 vs. 3.16 days, P < .001). On Cox regression, no difference in survival was observed between open and endoscopic patients (P = .534).

Patients with non-SCC sinonasal cancer managed with endoscopic surgery had a decreased LOS and no significant difference in survival compared to patients undergoing open resection. Therefore, an endoscopic approach may be considered a viable alternative to open resection.

NA Laryngoscope, 130: 1872-1876, 2020.