DOI: 10.1177/27534030261449548 ISSN: 2753-4030

Endoscopic Endonasal Approach for Surgical Treatment of Nasal and Ethmoidal Malignancies: A Retrospective Multicenter Study

Masayoshi Kobayashi, Toyoyuki Hanazawa, Takayuki Nakagawa, Nobuyoshi Otori, Yasushi Fujimoto, Satoru Kodama, Tetsuji Sanuki, Shuho Tanaka, Yosuke Ariizumi, Ken-ichi Nibu, Mami Matsunaga, Satoru Miyamaru, Naoki Nishio, Takashi Hirano, Takahiro Asakage
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Background

Endoscopic endonasal approach (EEA) has gained widespread acceptance as a surgical approach for treating sinonasal malignancies in the last decade.

Objectives

This study examined the validity of the EEA as a standard modality for the surgical treatment of sinonasal malignancies.

Design

A retrospective multicenter cohort study

Methods

This study included patients with nasoethmoidal malignancies who underwent initial surgical treatment between 2014 and 2016 at 10 tertiary referral hospitals in Japan. The EEA, craniofacial approach (CA), and EEA combined with CA (EEAwCA) were used as the surgical methods.

Results

The total number of participants was 110, with a median posttreatment observation period of 69 months. The olfactory cleft (26%) was the most frequent lesion site. Squamous cell carcinoma (29%) and olfactory neuroblastoma (24%) were the most frequently observed pathological classifications. EEA was performed in early-stage cases, and EEAwCA, which is frequently used for tumors that extend into the orbit and/or intracranial regions, was performed in advanced-stage cases. Negative-margin resection was achieved in 85%, 78%, and 64% of EEA, EEAwCA, and CA cases, respectively; postoperative radiotherapy was performed in 50%, 56%, and 36% of patients with EEA, EEAwCA, and CA, respectively; and the 5-year local control rates were 90%, 78%, and 82% for EEA, EEAwCA, and CA, respectively. En bloc resection for EEA, and postoperative irradiation for EEA and EEAwCA were associated with fewer local recurrences. Validation of the operation time, hospitalization period, intraoperative blood loss, and postoperative complications demonstrated the low invasiveness of the EEA.

Conclusion

The EEA is a minimally invasive surgical modality with preferable oncological outcomes for the treatment of nasoethmoidal malignancies when adequately planned.

Plain Language Summary

A look back at nose cancer surgery using a less invasive method through the nose

Purpose

This study looked at a newer, less invasive surgery called the endoscopic endonasal approach (EEA), which goes through the nose to remove tumors in the nose and nearby areas. The goal was to see if this method could be used as a standard treatment.

How the Study Was Done

Researchers looked back at 110 patients in Japan who had surgery for cancer in the nose and surrounding areas between 2014 and 2016. They had surgery using one of three methods:

EEA (through the nose)

CA (a more traditional open surgery)

EEA combined with CA (used for more serious cases)

What They Found

1)

Most patients had tumors in a part of the nose related to the sense of smell.

2)

The most common types of cancer were squamous cell carcinoma and a rare nerve-related tumor.
3)

The EEA was mostly used for early-stage cancers, and the combined method was used for more advanced cases.
4)

The cancer was completely removed in about 85% of EEA cases, 78% of combined cases, and 64% of traditional cases.
5)

People who had EEA had fewer side effects, lost less blood, and stayed in the hospital for a shorter time.
6)

After 5 years, the cancer had not come back in 90% of EEA cases, 78% of combined cases, and 82% of traditional cases.
7)

Patients who had radiation after surgery or had tumors removed in one piece had better results.

Conclusion

The EEA is a safe and effective option for treating certain nose cancers, especially when it's carefully planned. It causes less harm to the body and works well for early-stage cancers.

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