Ethmoid Adenocarcinoma-From Craniofacial to Endoscopic Resections: A Single-Institution Experience over 25 Years

Objectives. To identify factors that influence hospitalization time, complications, and prognosis of patients with ethmoid adenocarcinoma treated with different surgical techniques. Design. Single-institution retrospective review. Setting. Academic tertiary care center. Patients. Sixty-seven patients with ethmoid adenocarcinoma treated from January 1985 to August 2009 were retrospectively evaluated. Surgical treatment included endoscopic resection (n = 12), endoscopic resection with transnasal craniectomy (n = 17), cranioendoscopic resection (n = 9), external approaches limited to the ethmoid (n = 11), and craniofacial resection (n = 18). Main Outcome Measures. A Cox model was adopted to relate time to death to previous treatment, pT category, grade, and surgical technique. The impact of the same variables on hospitalization time and risk of complications was assessed by linear regression and logistic regression, respectively. Results. The risk of complications increased for pT4a-b lesions (P = .02) and craniofacial resection (P = .01). Hospitalization time increased by 6.3 days for cranioendoscopic resection (P = .03) and by 11.7 days for craniofacial resection (P < .001). Three- and 5-year overall survivals were 68.0% (standard error = 5.8%) and 48.4% (standard error = 6.9%). Three-year survival was 76.62% and 51.81% for previously untreated and treated patients, respectively, and it was 92.98% and 33.33% in patients treated with endoscopic techniques and craniofacial resection, respectively. Multivariate analysis showed that previous treatment (hazard ratio of death = 3.9, P = .01) and craniofacial resection (HR = 5.16, P = .05) were mainly associated with survival. Conclusions. Endoscopic techniques, in properly selected patients, were associated with a favorable oncologic outcome and a statistically significant reduction in both complication rate and hospitalization time. This study supports the role of endoscopic techniques in surgical treatment of ethmoid adenocarcinoma.