The role of endoscopic resection for selected patients with sinonasal squamous cell carcinoma
The role of endoscopic resection for selected patients with sinonasal squamous cell carcinoma
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内镜切除术对特定鼻窦鳞状细胞癌患者的作用
DOI：
10.1016/j.anl.2020.06.014
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发表时间：
2021
影响因子：
1.7
通讯作者：
Akihiro Homma
中科院分区：
文献类型：
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作者：
Yuji Nakamaru;Masanobu Suzuki;Satoshi Kano;Takatsugu Mizumachi;Nayuta Tsushima;Takayoshi Suzuki;Aya Honma;Akira Nakazono;Shogo Kimura;Rikiya Onimaru;Koichi Yasuda;Hiroki Shirato;Akihiro Homma
尽管内窥镜手术技术发展迅速，但由于鼻腔鼻窦鳞状细胞癌（SNSCC）的侵袭性，包括频繁复发和高死亡率，因此其手术的金标准仍然是开放性方法和整块切除。由于这个原因，很少有研究集中在SNSCC治疗内镜手术单独。本研究的目的是评估内镜手术对SNSCC患者的有效性。方法对15例连续接受内镜手术且未采用开放手术的SNSCC患者进行回顾性分析。我们仔细选择的患者，其肿瘤附着部位可以完全可视化，并完全切除通过endonasal approach.ResultsOf的15例患者中，4例（27%）被诊断为T1，7（47%）与T2，4（27%）与T3，没有患者与T4a或T4b疾病。15例患者中有4例（27%）显示手术切缘阳性。5年总生存率、疾病特异性生存率和局部控制率分别为72.4%、79.6%和92.9%。T1、T2和T3疾病的5年疾病特异性生存率分别为100%、75%和75%。阴性手术切缘的患者有一个更好的疾病特异性生存率比那些积极的手术切缘（p= 0.0253）。手术切缘阴性和肿瘤附着部位的良好观察被认为是SNSCC治疗的关键。
ObjectiveDespite of rapid advances in endoscopic surgery, the gold standard for sinonasal squamous cell carcinoma (SNSCC) surgery has remained the open approach with en-block resection due to the aggressive nature of SNSCC, including frequent recurrence and high mortality rate. For that reason, few studies have focused on SNSCC treated by endoscopic surgery alone. The objective of this study was to evaluate the usefulness of endoscopic surgery for patients with SNSCC.MethodsA retrospective analysis was performed for 15 consecutive SNSCC patients who underwent endoscopic surgery without an open approach. We carefully selected patients whose tumor attachment sites could be fully visualized and completely resected through an endonasal approach.ResultsOf the fifteen patients, 4 patients (27%) were diagnosed with T1, 7 (47%) with T2, 4 (27%) with T3, and no patients with T4a or T4b disease. Four of the 15 (27%) patients showed positive surgical margins. The 5-yr overall survival, disease-specific survival, and local control rate was 72.4%, 79.6%, and 92.9%, respectively. The 5-yr disease-specific survival for T1, T2, and T3 disease was 100% and 75% and 75%, respectively. Patients with negative surgical margins had a better disease-specific survival rate than did those with positive surgical margins (p= 0.0253).ConclusionEndoscopic surgery for patients with SNSCC appears to afford an effective method in selected cases. The achievement of negative surgical margins with a good view of the tumor attachment site was considered to be critical to the management of SNSCC.