Choice of surgery in intestinal-type adenocarcinoma of the sinonasal tract: a long-term comparative study

Tijl Vermassen; Stijn De Keukeleire; Michael Saerens; Sylvester Heerwegh; Jens M Debacker; Wouter Huvenne; Philippe Deron; David Creytens; Liesbeth Ferdinande; Sylvie Rottey; Claus Bachert; Fréderic Duprez; Thibaut Van Zele

doi:10.1007/s00405-024-08447-w

Choice of surgery in intestinal-type adenocarcinoma of the sinonasal tract: a long-term comparative study

Eur Arch Otorhinolaryngol. 2024 Jun;281(6):2993-3004. doi: 10.1007/s00405-024-08447-w. Epub 2024 Jan 16.

Authors

Tijl Vermassen^#^{1

2

3}, Stijn De Keukeleire^#⁴, Michael Saerens^{5

6

7}, Sylvester Heerwegh⁵, Jens M Debacker^{7

8

9}, Wouter Huvenne^{7

9

10}, Philippe Deron⁹, David Creytens^{7

11

12}, Liesbeth Ferdinande^{11

12}, Sylvie Rottey^{5

6

7}, Claus Bachert^{10

13}, Fréderic Duprez^{7

14

15}, Thibaut Van Zele^{10

13}

Affiliations

¹ Department Medical Oncology, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, Belgium. tijl.vermassen@uzgent.be.
² Biomarkers in Cancer, Ghent University, Ghent, Belgium. tijl.vermassen@uzgent.be.
³ Cancer Research Institute Ghent, Ghent, Belgium. tijl.vermassen@uzgent.be.
⁴ Department Internal Medicine, University Hospital Brussels, Brussels, Belgium.
⁵ Department Medical Oncology, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, Belgium.
⁶ Biomarkers in Cancer, Ghent University, Ghent, Belgium.
⁷ Cancer Research Institute Ghent, Ghent, Belgium.
⁸ Laboratory for Molecular Imaging and Therapy, Vrije Universiteit Brussel, Brussels, Belgium.
⁹ Department Head and Neck Surgery, University Hospital Ghent, Ghent, Belgium.
¹⁰ Upper Airway Research Laboratory, Ghent University, Ghent, Belgium.
¹¹ Department Pathology, University Hospital Ghent, Ghent, Belgium.
¹² Department Diagnostic Sciences, Ghent University, Ghent, Belgium.
¹³ Department Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium.
¹⁴ Department Radiation Oncology, University Hospital Ghent, Ghent, Belgium.
¹⁵ Department Human Structure and Repair, Ghent University, Ghent, Belgium.

^# Contributed equally.

PMID: 38228884
DOI: 10.1007/s00405-024-08447-w

Abstract

Purpose: Intestinal-type adenocarcinoma (ITAC) is a rare sinonasal malignancy. Curative treatment requires multidisciplinary approach, with surgical options consist of the endonasal endoscopic approach (EEA) and external surgery (EXTS). Here, we provide the post-operative and survival results from a single-center long-term follow-up.

Methods: We report long-term follow-up of 92 ITAC cases treated between 1998 and 2018, treated with EEA (n = 40) or EXTS (n = 52). Survival estimates, post-operative complications and duration of hospitalization were compared between surgical modalities.

Results: Baseline characteristics were similar. A higher number of T4b tumors (16%), and subsequently more tumoral invasion (39%), was present in patients undergoing EXTS compared to EEA (3% and 18%, respectively). No difference in Barnes histology subtypes was noticed. Patients undergoing EEA had a shorter post-operative hospitalization stay versus EXTS (4 versus 7 days). Use of EEA was associated to improved disease-specific survival (DSS; 11.4 versus 4.4 years; HR_EEA = 0.53), especially for patients with T3-4a tumors (11.4 versus 3.0 years; HR_EEA = 0.41). Patients with T3-4 stage, tumoral invasion, positive surgical margins, mucinous or mixed histology, and prolonged post-operative hospital stay showed poor local relapse-free, disease-free, overall, and DSS.

Conclusions: Long-term follow-up in locally advanced ITAC demonstrates that resection by EEA is correlated with improved DSS compared to EXTS, especially for T3-4 tumors. No significant differences between both treatment modalities was observed regarding per- and post-operative complications, although hospitalization in patients undergoing EEA was shorter than for patients treated with EXTS. These results confirm that EEA should remain the preferred surgical procedure in operable cases of sinonasal ITAC.

Keywords: Intestinal-type adenocarcinoma; Prognosis; Sinus carcinoma; Surgery.

Publication types

Comparative Study

MeSH terms

Adenocarcinoma* / mortality
Adenocarcinoma* / pathology
Adenocarcinoma* / surgery
Adult
Aged
Endoscopy / methods
Female
Follow-Up Studies
Humans
Length of Stay / statistics & numerical data
Male
Middle Aged
Neoplasm Staging
Paranasal Sinus Neoplasms* / mortality
Paranasal Sinus Neoplasms* / pathology
Paranasal Sinus Neoplasms* / surgery
Postoperative Complications / epidemiology
Retrospective Studies
Survival Rate