Lakshman Manjunath1, Taylor Derousseau1, Pete S Batra2. 1. University of Texas Southwestern Medical School, Dallas, TX. 2. Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL.
Abstract
BACKGROUND: Complete tumor resection with intraoperative frozen section control remains a central tenet of head and neck surgical oncology. The purpose of this study was to evaluate the significance of margins in predicting recurrence and disease status following endoscopic resection of sinonasal malignancy. METHODS: This single-institution observational cohort study was performed on 68 patients over a 5-year period who underwent curative minimally invasive endoscopic resection (MIER) for sinonasal malignancies. RESULTS: The mean age was 58.8 years and 69.1% were male. The mean follow-up after definitive MIER was 15.9 months. A mean of 10.8 margins were taken per surgery (range, 2 to 27). False-negative frozen section analysis was 22.1% for the entire cohort, but slightly higher at 25.0% for T3 or T4 malignancies. At last follow-up, no evidence of disease (NED) status was noted in 60.0% of those with positive margins vs 83.0% in those with negative margins, respectively (p = 0.0795). Regional or distant recurrences were observed in 39.9% of patients with positive margins and 13.2% of those with negative margins, respectively (p = 0.0299). Disease-free survival (DFS) was 9.7 months for patients with positive margins, whereas it was 15.9 months for patients with negative margins. CONCLUSION: Disease-free status as a function of residual microscopic disease did not prove to be statistically significant. However, positive margins were correlated with a statistically significant increase in regional or distant recurrence. This suggests that complete resection with clear margins can impact oncologic outcomes in patients managed by MIER for sinonasal cancers.
BACKGROUND: Complete tumor resection with intraoperative frozen section control remains a central tenet of head and neck surgical oncology. The purpose of this study was to evaluate the significance of margins in predicting recurrence and disease status following endoscopic resection of sinonasal malignancy. METHODS: This single-institution observational cohort study was performed on 68 patients over a 5-year period who underwent curative minimally invasive endoscopic resection (MIER) for sinonasal malignancies. RESULTS: The mean age was 58.8 years and 69.1% were male. The mean follow-up after definitive MIER was 15.9 months. A mean of 10.8 margins were taken per surgery (range, 2 to 27). False-negative frozen section analysis was 22.1% for the entire cohort, but slightly higher at 25.0% for T3 or T4 malignancies. At last follow-up, no evidence of disease (NED) status was noted in 60.0% of those with positive margins vs 83.0% in those with negative margins, respectively (p = 0.0795). Regional or distant recurrences were observed in 39.9% of patients with positive margins and 13.2% of those with negative margins, respectively (p = 0.0299). Disease-free survival (DFS) was 9.7 months for patients with positive margins, whereas it was 15.9 months for patients with negative margins. CONCLUSION: Disease-free status as a function of residual microscopic disease did not prove to be statistically significant. However, positive margins were correlated with a statistically significant increase in regional or distant recurrence. This suggests that complete resection with clear margins can impact oncologic outcomes in patients managed by MIER for sinonasal cancers.
Authors: Zachary P Hart; Naoki Nishio; Giri Krishnan; Guolan Lu; Quan Zhou; Shayan Fakurnejad; Peter John Wormald; Nynke S van den Berg; Eben L Rosenthal; Fred M Baik Journal: Laryngoscope Date: 2019-12-19 Impact factor: 3.325
Authors: Tiffany N Chao; Edward C Kuan; Charles C L Tong; Michael A Kohanski; M Sean Grady; James N Palmer; Nithin D Adappa; Bert W O'Malley Journal: J Neurol Surg B Skull Base Date: 2020-02-07