The role of endoscopic resection for selected patients with sinonasal squamous cell carcinoma

Abstract

Despite of rapid advances in endoscopic surgery, the gold standard for sinonasal squamous cell carcinoma (SNSCC) surgery has remained the open approach with en-block resection due to the aggressive nature of SNSCC, including frequent recurrence and high mortality rate. For that reason, few studies have focused on SNSCC treated by endoscopic surgery alone. The objective of this study was to evaluate the usefulness of endoscopic surgery for patients with SNSCC. Methods: A retrospective analysis was performed for 15 consecutive SNSCC patients who underwent endoscopic surgery without an open approach. We carefully selected patients whose tumor attachment sites could be fully visualized and completely resected through an endonasal approach. Results: Of the fifteen patients, 4 patients (27%) were diagnosed with T1, 7 (47%) with T2, 4 (27%) with T3, and no patients with T4a or T4b disease. Four of the 15 (27%) patients showed positive surgical margins. The 5-yr overall survival, disease-specific survival, and local control rate was 72.4%, 79.6%, and 92.9%, respectively. The 5-yr disease-specific survival for T1, T2, and T3 disease was 100% and 75% and 75%, respectively. Patients with negative surgical margins had a better disease-specific survival rate than did those with positive surgical margins (p = 0.0253). Conclusion: Endoscopic surgery for patients with SNSCC appears to afford an effective method in selected cases. The achievement of negative surgical margins with a good view of the tumor attachment site was considered to be critical to the management of SNSCC.

Endonasal endoscopic surgery for sinonasal squamous cell carcinoma from an oncological perspective

“…Regarding surgical margins, in the study by Nakamaru et al, 4 of the 15 patients (27%) showed positive surgical margins [21] . None of the patients with negative surgical margins ( n = 11) showed recurrence.…”

“…Nakamaru et al reported no postoperative complications among 15 consecutive SN-SCC patients who underwent exclusively EES [21] . Kılıc et al reported that hospital stay was significantly shorter in patients with SN-SCC treated with endoscopic resection (endoscopic: 2.50 days; open: 4.67 days; p < 0.0001) according to the National Cancer Database [35] .…”

“…Postoperative axial and coronal CT 10 months after surgery demonstrating no evidence of recurrent tumor (c and d, respectively). [21] . The surgery begins with debulking of the tumor with a microdebrider to identify the origin of the tumor (a).…”

“…Nakamaru et al reported a retrospective analysis of 15 consecutive SN-SCC patients who underwent exclusively EES [21] . The majority of patients had early stage disease, T1 or T2, and there were no cases of stage T4 disease.…”

“…Nakamaru et al mentioned that safe indications for EES for patients with SN-SCC were relatively limited disease, such as T1-2 disease, nasal cavity/ethmoid tumors and some T3 disease without bony destruction of the sinus walls [21] . According to the International Consensus Statement on Endoscopic Skull-Base Surgery published in 2019 [41] , expert opinion has suggested that the following criteria would indicate that a patient is not an appropriate candidate for endoscopic resection of SN-SCC if the following structures are involved: hard palate, anterior maxillary, inferior maxillary, extensive posterior maxillary, orbital floor, ascending process of the maxilla, nasal bone, anterior table of the frontal sinus, or posterior table of the frontal sinus osseous extension, soft palate extension, extensive pterygopalatine fossa/infratemporal fossa extension, cranial nerve extension to or beyond the respective skull-base foramen, cavernous sinus extension, orbital extension, brain parenchymal extension, or involvement of the soft tissues of the face.…”