Endoscopic Surgery As Effective Open Surgery For Nasal Cancer

Esthesioneuroblastoma is a very rare cancer that develops in the upper part of the nasal cavity and 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.

According to the BUSM researchers, the complex nature of this tumor has led to much debate regarding the optimal treatment modality. Several previous studies have analyzed survival rates of various treatments, the majority of which have shown 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.

This study examined recent literature regarding outcomes of esthesioneuroblastoma treatment between 1992 and 2008 and found overall, surgery yielded more disease-free outcomes and better survival rates than nonsurgical treatment modalities. Endoscopic surgery produced better survival rates than open surgery. In addition, there was no significant difference between follow-up times in the endoscopic and open surgery groups.

"We did find a statistically significant difference between the study publication years of the open and endoscopic surgery groups because the open surgery literature considerably predated endoscopic treatment. To account for this discrepancy, we grouped the data according to publication year and performed further analysis and found the endoscopic surgery group maintained better survival rates than the open surgery group," said lead author Anand K. Devaiah, MD, FACS, an assistant professor in the departments of otolaryngology - head and neck surgery and neurological surgery as well as an attending in the department of otolaryngology at Boston Medical Center. He and his co-author, BUSM III student Michael Andreoli, presented their work at the Triological Society Eastern Section Meeting, which was met with great enthusiasm.

"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," added Devaiah. "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."

These findings appear in the July issue of Laryngoscope.