Suat Kılıç1, Sarah S Kılıç2, Soly Baredes1,3, Richard Chan Woo Park1, Omar Mahmoud2, Jeffrey D Suh4, Stacey T Gray5,6, Jean Anderson Eloy1,3,7,8. 1. Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ. 2. Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ. 3. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ. 4. Department of Head and Neck Surgery, University of California at Los Angeles David Geffen School of Medicine, Los Angeles, CA. 5. Department of Otolaryngology, Harvard Medical School, Boston, MA. 6. Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA. 7. Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ. 8. Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ.
Abstract
BACKGROUND: The use of endoscopic resection as an alternative to open surgery for sinonasal malignancies has increased in the past 20 years. METHODS: The National Cancer Database was queried for cases of sinonasal squamous cell carcinoma (SNSCC) without cervical or distant metastases that were treated surgically between 2010 and 2014. They were split into 2 groups based on surgical approach: open or endoscopic. Demographics, facility and insurance type, stage, tumor characteristics, postoperative treatment, 30-day readmission rate, 30- and 90-day mortality, and overall survival (OS) were compared between the 2 groups. Cox proportional hazard analysis was performed. Propensity score matching (PSM) was used to mimic a randomized, controlled trial. RESULTS: A total of 1,483 patients were identified: 353 (23.8%) received endoscopic and 1130 (76.2%) received open surgery. Age, gender, race, geographic region, tumor size, surgical margins, postoperative chemoradiation, and 30-day readmissions did not vary significantly between the 2 groups. Open surgery was more common in academic centers (62.8% vs 54.2%; p = 0.004), less common for tumors of the ethmoid and sphenoid sinus (p < 0.0001), less common for stage IVB tumors, and associated with longer hospital stay (mean, 4.67 days vs 2.50 days; p < 0.0001). Five-year OS (5Y-OS) was not significantly different between the 2 approaches (p = 0.953; open: 5Y-OS, 56.5%; 95% confidence interval, 51.3% to 61.6%; endoscopic: 5Y-OS, 46.0%; 95% confidence interval, 33.2% to 58.8%). In the PSM cohort of 652 patients, there was also no significant difference in OS (p = 0.850). CONCLUSION: Endoscopic surgery is an effective alternative to open surgery, even after accounting for confounding factors that may favor its use over the open approach. It is also associated with a shorter hospital stay.
BACKGROUND: The use of endoscopic resection as an alternative to open surgery for sinonasal malignancies has increased in the past 20 years. METHODS: The National Cancer Database was queried for cases of sinonasal squamous cell carcinoma (SNSCC) without cervical or distant metastases that were treated surgically between 2010 and 2014. They were split into 2 groups based on surgical approach: open or endoscopic. Demographics, facility and insurance type, stage, tumor characteristics, postoperative treatment, 30-day readmission rate, 30- and 90-day mortality, and overall survival (OS) were compared between the 2 groups. Cox proportional hazard analysis was performed. Propensity score matching (PSM) was used to mimic a randomized, controlled trial. RESULTS: A total of 1,483 patients were identified: 353 (23.8%) received endoscopic and 1130 (76.2%) received open surgery. Age, gender, race, geographic region, tumor size, surgical margins, postoperative chemoradiation, and 30-day readmissions did not vary significantly between the 2 groups. Open surgery was more common in academic centers (62.8% vs 54.2%; p = 0.004), less common for tumors of the ethmoid and sphenoid sinus (p < 0.0001), less common for stage IVB tumors, and associated with longer hospital stay (mean, 4.67 days vs 2.50 days; p < 0.0001). Five-year OS (5Y-OS) was not significantly different between the 2 approaches (p = 0.953; open: 5Y-OS, 56.5%; 95% confidence interval, 51.3% to 61.6%; endoscopic: 5Y-OS, 46.0%; 95% confidence interval, 33.2% to 58.8%). In the PSM cohort of 652 patients, there was also no significant difference in OS (p = 0.850). CONCLUSION: Endoscopic surgery is an effective alternative to open surgery, even after accounting for confounding factors that may favor its use over the open approach. It is also associated with a shorter hospital stay.
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