Endoscopic Surgery as Effective as Open Surgery for Nasal Cancer

Researchers from Boston University School of Medicine (BUSM, MA, USA) and Boston Medical Center (MA, USA) conducted a meta-analysis of 23 studies comprising 361 patients treated for esthesioneuroblastoma between 1992 and 2008. The overall treatment and outcome at final follow-up of each patient was recorded. Patients were pooled according to treatment techniques and compared to one another using a Kaplan-Meier survival curve and the Mann-Whitney U test to examine differences in follow-up times and publication years.

The researchers found that surgery yielded more disease-free outcomes and better survival rates than nonsurgical treatment modalities. Log-rank tests showed a greater published survival rate for endoscopic surgery compared to open surgery, even when stratifying for publication year. There was no significant difference in follow-up time. Additionally, review of Kadish tumor staging for each modality showed larger tumors were more often treated with an open approach, but open and endoscopic survival measures were comparable. The study was published in the July 2009 issue of Laryngoscope.

"Although this meta-analysis suggests that the efficacy of endoscopic and endoscopic-assisted surgery is comparable to open surgery for less invasive tumors, further prospective studies are required to establish more definite conclusions, especially for larger tumors,” said lead author Anand Devaiah, M.D., an assistant professor in the departments of otolaryngology neurological surgery. "It helps validate this revolutionary method of surgery that we perform here at BMC, one of the few centers in the world that can offer patients endoscopic skull base surgery for these and other skull base tumors.”

Esthesioneuroblastoma is a very rare cancer that develops in the upper part of the nasal cavity and is thought to derive from neural tissue associated with the sense of smell. While this tumor generally grows slowly, in some cases it progresses rapidly and aggressively; the faster growing tumors are capable of widespread metastasis. The complex nature of this tumor has led to much debate regarding the optimal treatment modality, with the majority of studies showing that the most effective strategy is a combination of surgery and radiotherapy with or without chemotherapy. However, the evolution of surgical techniques has created another surgical option in the form of endoscopic surgery.

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