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[Endoscopic surgery for advanced malignant nasal and sinus tumors].

OBJECTIVE
To evaluate the effect of endoscopic surgery for advanced malignant tumors in the nasal cavity and paranasal sinuses.


METHODS
A retrospective data analysis was performed on 49 patients with advanced sinonasal tumors undergoing either an exclusive endoscopic approach or with a complemental approach from January 2004 to October 2010. Forty-nine patients were considered eligible for the present analysis, among them, T3:T4a:T4b were 12:13:24 (T stage was assessed with the sixth editions of the UICC staging systems). The histotypes encountered were squamous cell carcinoma 20 cases, adenocarcinoma 12 cases, mucosal melanoma 8 cases, olfactory neuroblastoma 6 cases, others 3 cases. These patients were operated on either by an exclusive endoscopic endonasal approach or with a complementary external approach; 36 patients received adjuvant radiotherapy or/and chemotherapy. The data were analyzed by Kaplan-Meier method and Log-rank test.


RESULTS
The hemorrhage varied from 200 to 5000 ml during the operation, with an average of 600 ml. The post-operative complications were rare, 1 patient lost her sight after operation, and no patient got infected at the site of operation (nor intracranial infection). After full amount of radiotherapy, no cerebrospinal fluid rhinorrhea was found. Four patients (8.2%) lost to follow-up. Sixteen patients died during the follow-up period, only three of them were without craniocerebral or orbital invasion. Four in 9 patients in the other pathological group (with the pathology of olfactory neuroblastoma or glioma etc), which had a poor prognosis, died during the follow-up period, of them, 3 had definitive evidence of intracranial metastasis, and none of the nine patients had been followed-up beyond 25 months. The 2 and 3 year disease-free rates were 34.2% and 21.4%, and overall survival rates were 62.5% and 58.4% respectively. The T stage, margin status, and whether accepted post operative adjuvant therapy were significant factors in predicting disease recurrence (χ² were 7.7, 4.9, 6.8 respectively and P < 0.05).


CONCLUSIONS
Now the endoscopic techniques with or without complementary approaches is an effective way for complete tumor removal. With postoperative complementary therapy, it provides a satisfactory survival rate with few side effects and better quality of life.