Prognostic Value of Surgical Margins During Endoscopic Resection of Paranasal Sinus Malignancy
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BACKGROUND: Complete tumor resection with intraoperative frozen section control remains a central tenet of head and neck surgical oncology. The purpose of the present study was evaluate the significance of margins in predicting local recurrence and disease status following endoscopic resection of sinonasal cancer. METHODS: This single-institution observational cohort study was performed on 68 patients over a 5-year period that underwent curative minimally invasive endoscopic resection (MIER) for sinonasal malignancies. RESULTS: The mean age was 58.8 years and 69.1% were male. The mean follow-up after definitive MIER was 15.9 months. A mean of 10.8 margins were taken per surgery (range 2 - 27). False negative frozen section analysis was 22.1% for the entire cohort, being slightly higher at 25.0% for T3 or T4 malignancies. At the last follow-up, no evidence of disease (NED) status was noted in 60.0% of those with positive margins versus 83.0% in those with negative margins, respectively (p = 0.0795). Regional or distant recurrences were observed in 39.9% of patients with positive margins and 13.2% of those with negative margins, respectively. Disease free survival (DFS) was 9.7 months for patients with positive margins, whereas those with negative margins had a DFS of 15.9 months. CONCLUSION: Statistical significance could not be achieved regarding the prognostic value of margin status on patient outcome. However, NED status as a function of residual microscopic disease proved to be marginally significant. These results suggest that complete resection with clear margins may reduce mortality in patients undergoing MIER for cancers of the paranasal sinuses.