1Department of Neurosurgery, and.
2Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
J Neurosurg. 2023 Sep 22;140(3):688-695. doi: 10.3171/2023.7.JNS23786. Print 2024 Mar 1.
Expanded endoscopic approaches (EEAs) are increasingly used for the definitive management of sinonasal malignancies. EEAs, in appropriately selected cases, provide similar oncological outcomes but are associated with lower complication rates compared with open surgical approaches. Selection bias is a limitation reported in previous studies comparing EEAs and open surgical approaches for the management of sinonasal malignancies. To address this issue, in this study the authors compared the long-term oncological outcomes of an anatomically matched cohort of patients with locally advanced sinonasal malignancies with skull base involvement (T4 stage). The specific objective of this study was to investigate the extent of resection (EOR), overall survival (OS), and disease progression between the EEA and open surgical cohorts.
A cohort of 42 patients with locally advanced sinonasal malignancies and skull base involvement (stage T4) and operated on via an EEA was matched anatomically with a cohort of 54 patients who had undergone open surgery. A retrospective chart review was conducted on these 96 patients who were treated between September 1993 and June 2020. All patients in the cohort were eligible for either an EEA or open surgery according to anatomical criteria. Patients of all ages were included, and the minimum follow-up required for eligibility was 4 months. Patients were excluded if surgery was not offered for curative intent and preoperative imaging did not demonstrate that gross-total resection was achievable.
There were more complications in the conventional surgery cohort than in the EEA cohort (33.33% vs 14.29%, p = 0.033). There was no significant difference in the EOR between the EEA and conventional surgery cohorts, as demonstrated by comparable rates of positive margins in both groups (5.56% vs 2.38%, respectively). Disease progression (hazard ratio [HR] 0.47, 95% CI 0.17-1.27, p = 0.137) was lower and OS (HR 0.58, 95% CI 0.26-1.29, p = 0.183) was higher in the EEA cohort, but these findings did not reach statistical significance.
The EEA was found to be associated with lower risks of complications than conventional craniofacial surgical approaches. There were no significant differences in OS and progression-free survival between the EEA and conventional surgical cohorts when comparing anatomically matched cohorts of patients with stage T4 sinonasal malignancies and skull base involvement.
扩展内镜入路（EEA）越来越多地用于鼻窦恶性肿瘤的确定性治疗。在适当选择的病例中，EEA 提供了相似的肿瘤学结果，但与开放式手术方法相比，并发症发生率较低。在比较鼻窦恶性肿瘤的 EEA 和开放式手术方法的先前研究中，报道了选择偏差是一个限制。为了解决这个问题，本研究作者比较了一组具有解剖学匹配的局部晚期鼻窦恶性肿瘤伴颅底受累（T4 期）患者的长期肿瘤学结果。本研究的具体目的是研究 EEA 和开放式手术队列之间的切除程度（EOR）、总生存率（OS）和疾病进展。
一组 42 例局部晚期鼻窦恶性肿瘤伴颅底受累（T4 期）并通过 EEA 手术的患者与一组 54 例接受开放式手术的患者在解剖学上相匹配。对这些于 1993 年 9 月至 2020 年 6 月期间接受治疗的 96 例患者进行了回顾性图表审查。根据解剖学标准，所有队列中的患者均有资格接受 EEA 或开放式手术。包括所有年龄段的患者，符合条件的最低随访时间为 4 个月。如果手术不是出于治愈目的而提供，并且术前影像学检查未显示可实现大体全切除，则将患者排除在外。
传统手术组的并发症多于 EEA 组（33.33%比 14.29%，p=0.033）。两组的 EOR 没有显著差异，两组的阳性边缘率相当（分别为 5.56%和 2.38%）。在 EEA 队列中，疾病进展（风险比 [HR]0.47，95%置信区间 [CI]0.17-1.27，p=0.137）较低，总生存率（HR0.58，95%CI0.26-1.29，p=0.183）较高，但这些发现没有统计学意义。
与传统的颅面外科手术方法相比，EEA 与较低的并发症风险相关。在比较具有 T4 期鼻窦恶性肿瘤和颅底受累的解剖学匹配队列时，EEA 队列与传统手术队列之间的总生存率和无进展生存率无显著差异。
