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

Daniel M Beswick; Peter H Hwang; Nithin D Adappa; Christopher H Le; Ian M Humphreys DO; Anne E Getz; Jeffrey D Suh; Davis M Aasen; Waleed M Abuzeid; Eugene H Chang; Alexander M Kaizer; Todd T Kindgom; Michael A Kohanski; Seyed Ali Nabavizadeh; Jayakar V Nayak; James N Palmer; Zara M Patel; Vijay R Ramakrishnan; Carl H Snyderman; Maie A St John; Jessica Wild; Eric W Wang

doi:10.1002/alr.22833

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

Int Forum Allergy Rhinol. 2021 Dec;11(12):1617-1625. doi: 10.1002/alr.22833. Epub 2021 Jun 27.

Authors

Daniel M Beswick¹, Peter H Hwang², Nithin D Adappa³, Christopher H Le⁴, Ian M Humphreys DO⁵, Anne E Getz⁶, Jeffrey D Suh¹, Davis M Aasen⁶, Waleed M Abuzeid⁵, Eugene H Chang⁴, Alexander M Kaizer⁷, Todd T Kindgom⁶, Michael A Kohanski³, Seyed Ali Nabavizadeh⁸, Jayakar V Nayak², James N Palmer³, Zara M Patel², Vijay R Ramakrishnan⁶, Carl H Snyderman⁹, Maie A St John¹, Jessica Wild⁷, Eric W Wang⁹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, CA.
² Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA.
³ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Pennsylvania, Philadelphia, PA.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, AZ.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA.
⁶ Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, CO.
⁷ Department of Biostatistics and Informatics, University of Colorado, Aurora, CO.
⁸ Department of Radiology, University of Pennsylvania, Philadelphia, PA.
⁹ Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA.

PMID: 34176231
DOI: 10.1002/alr.22833

Abstract

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.

Keywords: complications; endoscopic; malignancy; sinonasal cancer; surgical resection.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Humans
Nose Neoplasms* / surgery
Paranasal Sinus Neoplasms* / epidemiology
Paranasal Sinus Neoplasms* / surgery
Prospective Studies
Retrospective Studies
Treatment Outcome