title: Prognostic value of surgical margins during endoscopic resection of paranasal sinus malignancy.
abstract: BACKGROUND
  Complete tumor resection with intraoperative frozen section control remains a central tenet of head and neck surgical oncology. The purpose of this study was to evaluate the significance of margins in predicting recurrence and disease status following endoscopic resection of sinonasal malignancy.
  
  
  METHODS
  This single-institution observational cohort study was performed on 68 patients over a 5-year period who underwent curative minimally invasive endoscopic resection (MIER) for sinonasal malignancies.
  
  
  RESULTS
  The mean age was 58.8 years and 69.1% were male. The mean follow-up after definitive MIER was 15.9 months. A mean of 10.8 margins were taken per surgery (range, 2 to 27). False-negative frozen section analysis was 22.1% for the entire cohort, but slightly higher at 25.0% for T3 or T4 malignancies. At last follow-up, no evidence of disease (NED) status was noted in 60.0% of those with positive margins vs 83.0% in those with negative margins, respectively (p = 0.0795). Regional or distant recurrences were observed in 39.9% of patients with positive margins and 13.2% of those with negative margins, respectively (p = 0.0299). Disease-free survival (DFS) was 9.7 months for patients with positive margins, whereas it was 15.9 months for patients with negative margins.
  
  
  CONCLUSIONS
  Disease-free status as a function of residual microscopic disease did not prove to be statistically significant. However, positive margins were correlated with a statistically significant increase in regional or distant recurrence. This suggests that complete resection with clear margins can impact oncologic outcomes in patients managed by MIER for sinonasal cancers.
authors.affiliation: University of Texas Southwestern Medical School, Dallas, TX.
authors.forename: Lakshman
authors.initials: L
authors.lastname: Manjunath
authors.affiliation: University of Texas Southwestern Medical School, Dallas, TX.
authors.forename: Taylor
authors.initials: T
authors.lastname: Derousseau
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Pete S
authors.initials: PS
authors.lastname: Batra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult
keywords: cancer; endoscopy; malignancy; neoplasm; paranasal; sinus; skull base; surgical margin