Efficacy of transnasal endoscopic resection for malignant anterior skull-base tumors.
BACKGROUND
Craniofacial resection (CFR) has been the standard of care for malignant tumors of the anterior skull base (ASB). However, during the past 2 decades, transnasal endoscopic resection (TER) has gained significant popularity. The purpose of this study is to compare CFR and TER with respect to perioperative and oncologic outcomes.


METHODS
Retrospective analysis at a tertiary care medical center of 82 consecutive patients undergoing resection of tumors of the ASB between 1997 and 2011.


RESULTS
Thirty-four patients underwent TER, while 48 patients underwent CFR. There was no statistical difference in major complications between the two groups (p = 0.29). However, TER patients had shorter operating room times (284 minutes for TER, 620 minutes for CFR; p < 0.001), lower intraoperative blood loss (675 mL for TER, 1000 mL for CFR; p = 0.005), shorter intensive care unit (ICU) stays (0 days for TER, 3 days for CFR; p < 0.001), and shorter hospital stays (4.5 days for TER; 7 days for CFR; p < 0.001). There were no differences for the rates of en bloc resection, negative margins, or disease-specific mortality. Subanalysis yielded a median follow-up of 5 years postoperatively. There were no differences in disease-specific mortality or recurrences in this group.


CONCLUSIONS
Patients undergoing TER for tumors of the ASB are more likely to leave the ICU and the hospital earlier than their CFR counterparts. Furthermore, for carefully selected patients undergoing TER, excellent oncologic outcomes with survival and recurrence rates similar to patients undergoing CFR may be achieved. Comparison of oncologic outcomes, however, may be limited by discrepancy in histologic grade and clinical stage between the two groups. Nonetheless, TER seems to be an excellent alternative to CFR in appropriately selected patients.
Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL.
John W
JW
Wood
Jean Anderson
JA
Eloy
Richard J
RJ
Vivero
Zoukaa
Z
Sargi
Francisco J
FJ
Civantos
Donald T
DT
Weed
Jaques J
JJ
Morcos
Johnathan
J
Castaño
Kaming
K
Lo
Roy R
RR
Casiano
D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004724:Endoscopy / Q000379:methods*; D005145:Face / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D061646:Operative Time; D010256:Paranasal Sinuses / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome