Surgical approach is associated with complication rate in sinonasal malignancy: A multicenter study.

TitleSurgical approach is associated with complication rate in sinonasal malignancy: A multicenter study.
Publication TypeJournal Article
Year of Publication2021
AuthorsBeswick DM, Hwang PH, Adappa ND, Le CH, DO IMHumphrey, Getz AE, Suh JD, Aasen DM, Abuzeid WM, Chang EH, Kaizer AM, Kindgom TT, Kohanski MA, Nabavizadeh SAli, Nayak JV, Palmer JN, Patel ZM, Ramakrishnan VR, Snyderman CH, St John MA, Wild J, Wang EW
JournalInt Forum Allergy Rhinol
Date Published2021 12
KeywordsCohort Studies, Humans, Nose Neoplasms, Paranasal Sinus Neoplasms, Prospective Studies, Retrospective Studies, Treatment Outcome

BACKGROUND: Management of sinonasal malignancy (SNM) often includes surgical resection as part of the multimodality treatment. Treatment-related surgical morbidity can occur, yet risk factors associated with complications in this population have not been sufficiently investigated.

METHODS: Adult patients with histologically confirmed SNM whose primary treatment included surgical resection were prospectively enrolled into an observational, multi-institutional cohort study from 2015 to 2020. Sociodemographic, disease, and treatment data were collected. Complications assessed included cerebrospinal fluid leak, orbital injury, intracranial injury, diplopia, meningitis, osteoradionecrosis, hospitalization for neutropenia, and subsequent chronic rhinosinusitis. The surgical approach was categorized as endoscopic resection (ER) or open/combined resection (O/CR). Associations between factors and complications were analyzed using Student's t test, Fisher's exact test, and logistic regression modeling.

RESULTS: Overall, 142 patients met the inclusion criteria. Twenty-three subjects had at least 1 complication (16.2%). On unadjusted analysis, adjuvant radiation therapy was associated with developing a complication (91.3% vs 65.5%, p = 0.013). Compared with the ER group (n = 98), the O/CR group (n = 44) had a greater percentage of higher T-stage lesions (p = 0.004) and more frequently received adjuvant radiation (84.1% vs 64.4%, p = 0.017) and chemotherapy (50.0% vs 30.6%, p = 0.038). Complication rates were similar between the ER and O/CR groups without controlling for other factors. Regression analysis that retained certain factors showed O/CR was associated with increased odds of experiencing a complication (odds ratio, 3.34; 95% confidence interval, 1.06-11.19).

CONCLUSIONS: Prospective, multicenter evaluation of SNM treatment outcomes is feasible. Undergoing O/CR was associated with increased odds of developing a complication after accounting for radiation therapy. Further studies are warranted to build upon these findings.

Alternate JournalInt Forum Allergy Rhinol
PubMed ID34176231
Faculty Reference: 
Eugene H. Chang, MD
Christopher Le, MD, FACS