Comparative Outcomes by Surgical Approach in Patients with Malignant Sinonasal Disease

 There is a paucity of data on comparative outcomes for open versus endoscopic surgery for patients with malignant sinonasal pathology. Most of the available studies are limited by a sample size <100 patients.  This is a retrospective cohort study.  The findings of this study come from a single-institution tertiary care center from 2008 to 2019.  In total, 199 patients who underwent surgery for malignant sinonasal disease participated in this study.  The main outcome measures were perioperative complications and reoperation.  Patients in our sample had a mean age of 59.7 years (SD, 20.4). In total, 62% were male and 72% were white. An endoscopic-only approach was used in 41% of patients and an open or combined approach in 59% of patients. Squamous cell carcinoma was the most common pathology (43.0%), followed by sarcoma (9.5%), skin cancer (6.5%), sinonasal undifferentiated carcinoma (6.5%), and adenocarcinoma (5.5%). The all-cause complication rate was 14.6%. Patients with an open resection had a higher rate of intraoperative complications (5.9 vs. 0%;  = 0.043), postoperative complications (19.5 vs. 3.7%;  = 0.001), and all-cause complications (21.0 vs. 3.7%;  < 0.001). The likelihood of early reoperation (<6 months) or late reoperation (>6 months) did not significantly differ by surgical approach (  = 1.000 and 0.741, respectively).  The endoscopic approach for resection of malignant sinonasal disease is viable for select patients and may be associated with a favorable complication rate compared with the open approach.