Open versus endoscopic craniofacial resections in sinonasal adenocarcinoma: long term follow up from two institutions.

Abstract

Background: Sinonasal adenocarcinomas are a rare malignancy, and historically surgically resected via open craniofacial resections. With the rise of endoscopic techniques, there has been a shift in addressing these tumours via an endoscopic approach. This project aimed to assess the surgical outcomes from two institutions in Melbourne, Australia, and ensure oncologic outcomes are maintained with a switch to an endoscopic approach.

Methods: Retrospective analysis of patients undergoing craniofacial resection for adenocarcinoma at two tertiary centres between 2011 and 2023. Open/combined and endoscopic craniofacial approaches were included for analysis, assessing TNM staging, margin status, hospital LOS, adjuvant radiotherapy, and complications. Statistical analysis was performed on these variables to investigate their significance on outcomes.

Results: Over eleven years, 27 patients were analysed and divided into endoscopic (n = 16) and open/combined (n = 11) cohorts. Mean age 67.0 (±12.1 SD), with one female patient (3.7%), with the majority of cases T3/4 (74%). Five patients (18.5%), one endoscopic (6.3%) and four open (36.4%) developed recurrence during the follow-up period (P = 0.141). Complication rates were similar between groups, endoscopic (18.8%) and open (27.3%) (P = 0.872). Five-year disease-free survival and overall survival were 85.2% and 88.9%, respectively. No factors included had statistical influence over survival.

Conclusion: This study examined outcomes for sinonasal adenocarcinoma in the post-endoscopic era in Australia at two tertiary centres. The rate of recurrence was lower for endoscopic craniofacial resection, with similar complication rates compared with an open approach. This reinforces endoscopic craniofacial resection as an appropriate alternative surgical technique in selected populations.