Comparing endoscopic resection and open resection for management of sinonasal mucosal melanoma.

BACKGROUND

Sinonasal mucosal melanoma (SMM) is a rare, aggressive cancer, optimally managed with complete surgical resection. This study aimed to assess the impact of surgical approach on outcomes by comparison of cases managed with open vs endoscopic resection.

METHODS

The National Cancer Database 2010-2015 datasets were queried for all cases of non-metastatic SMM initially managed with definitive surgery. Patients were grouped according to surgical approach (open vs endoscopic) and compared for patient, tumor, and treatment variables using chi-square analyses. Case-control matching was used to generate subgroups of cases paired 1:1 between groups, matched for significantly distributed variables. Subgroups were compared for perioperative outcomes and overall survival (OS) using Kaplan-Meier analyses.

RESULTS

Of the 686 cases of SMM managed with definitive surgery, 46.2% were treated endoscopically. Open and endoscopic groups did not differ significantly by T-stage, primary site, or rates of adjuvant therapies. Case-control matching for these variables generated a subpopulation of 240 paired cases. Comparison of matched groups found no significant differences in 30-day or 90-day mortality. Endoscopically managed patients had higher rates of unplanned readmission whereas open resection patients had longer length of stay (LOS). There was no significant difference in OS between groups.

CONCLUSION

In surgically managed SMM, open resection patients have significantly longer LOS, whereas endoscopic patients have higher rates of unplanned readmission. Surgical approach does not appear to influence OS.