Background: With evolving visualization and guidance techniques, endoscopic approaches to sinonasal malignancies have been increasingly utilized. Esthesioneuroblastoma (ENB) is a rare malignant neoplasm of the sinonasal cavity. Surgery followed by radiotherapy is the mainstay of treatment. However, differences between endoscopic and open surgical approaches to resection have not been well studied. This study utilizes the National Cancer Database (NCDB) to both compare outcomes, as well as characterize demographic and clinical factors associated with each approach.
Methods: The National Cancer Database was queried for cases of primary ENB corresponding to the nasal cavity and paranasal sinuses. Patients that were operated between 2010 and 2014 were included. Multivariable logistic analysis was used to compare factors associated with open compared to endoscopic surgical approaches. Cox proportional hazard ratios with propensity score matching were utilized in the comparison of overall survival (OS) between the cohorts.
Results: A total of 634 patients underwent surgery for ENB, 47.8% received endoscopic surgery, 52.2% received open surgery. The demographic factors age, sex, race, ethnicity, and median income did not differ significantly between groups. Tumor size, tumor margin, primary site, additional post-operative chemotherapy or radiotherapy, and facility type also did not vary significantly between open and endoscopic approaches. Endoscopic approach was used in 57.1% of Kadish Stage A & B tumors, and 42.2% of Kadish Stage C & D tumors (p<.001). Open surgeries were associated with public insurance (p=0.047). Endoscopic surgery was associated with shorter length of stay (4.3 vs. 6.8 days, p<0.001); there was no significant differences in 30 day readmission or 90 day mortality. Increased age (p<0.001) and advanced Kadish stages (C&D) (p=0.012) were associated with worse survival on multivariate Cox analysis. 5 year overall survival was higher in the endoscopic group (91.0% vs. 85.5%, p=0.048). Utilizing propensity score matching for age, sex, tumor size, margins, and Kadish stages, OS tended to be higher in the endoscopic group, but this difference did not reach statistical significance (p=0.052).
Conclusion: Nationally, about half of ENBs are treated endoscopically, currently more so in lower stage disease. These data support that endoscopic resection be an effective, less-invasive alternative to open resection, while affording similar overall survival outcomes to the open approach even after accounting for Kadish stage.