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

Abstract

PurposeThe 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.MethodsPatients 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.ResultsA 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.ConclusionOur 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.

Surgical Interventions for Advanced Parameningeal Rhabdomyosarcoma of Children and Adolescents

“…Since the 1960s, craniofacial resection has been the surgical method of choice since it allows wide excision with a satisfactory margin [ 36 ]. However, the method commonly led to major functional and cosmetic morbidities [ 36 ], the most common functional defect being cerebrospinal fluid (CSF) leakage in up to 20% of all cases [ 36 ].…”

“…Since the 1960s, craniofacial resection has been the surgical method of choice since it allows wide excision with a satisfactory margin [ 36 ]. However, the method commonly led to major functional and cosmetic morbidities [ 36 ], the most common functional defect being cerebrospinal fluid (CSF) leakage in up to 20% of all cases [ 36 ]. In contrast, MIER minimizes handling of the skull base and prevents the morbidity and further complications that conventional resection delivers, i.e., meningitis, cerebral abscess, pneumocephalus, brain herniation and, consequently, even death [ 36 ].…”

“…However, the method commonly led to major functional and cosmetic morbidities [ 36 ], the most common functional defect being cerebrospinal fluid (CSF) leakage in up to 20% of all cases [ 36 ]. In contrast, MIER minimizes handling of the skull base and prevents the morbidity and further complications that conventional resection delivers, i.e., meningitis, cerebral abscess, pneumocephalus, brain herniation and, consequently, even death [ 36 ]. This reduction in morbidity not only improves quality of life, it also shortens the period of hospital stay and reduces healthcare costs [ 36 - 37 ].…”

Implications of DNA Damage and Induction of DNA Repair Gene Expression in Cutaneous vs Mucosal Melanoma

“…The cause of these tumors, therefore, is unclear. Mucosal melanoma is rare compared to CM and is often diagnosed at a much later and more advanced stage [2]. By studying the human repair genes homologous to those associated with DNA repair in Deinococcus, there is potential to discover new pathways of mutagenesis, pathological mechanisms, and mutations that could provide early detection markers or targets for therapies [3].…”

“…This meta-analysis initially found no correlation between the XRCC3 T241M polymorphism and melanoma when analyzing 6 case-control studies that included 2,133 patients and 3,141 controls. However, in a subsequent meta-analysis of 3 studies that consisted of 500 cases, there was a significant association made between the XRCC3 T241M polymorphism and melanoma [2]. These studies have analyzed the mutational status in XRCC3in regard to melanoma but do not address gene expression.…”