Expanded endoscopic approaches (EEAs) are increasingly used for the definitive management of sinonasal malignancies. EEAs, in appropriately selected cases, provide similar oncological outcomes but are associated with lower complication rates compared with open surgical approaches. Selection bias is a limitation reported in previous studies comparing EEAs and open surgical approaches for the management of sinonasal malignancies. To address this issue, in this study the authors compared the long-term oncological outcomes of an anatomically matched cohort of patients with locally advanced sinonasal malignancies with skull base involvement (T4 stage). The specific objective of this study was to investigate the extent of resection (EOR), overall survival (OS), and disease progression between the EEA and open surgical cohorts.

A cohort of 42 patients with locally advanced sinonasal malignancies and skull base involvement (stage T4) and operated on via an EEA was matched anatomically with a cohort of 54 patients who had undergone open surgery. A retrospective chart review was conducted on these 96 patients who were treated between September 1993 and June 2020. All patients in the cohort were eligible for either an EEA or open surgery according to anatomical criteria. Patients of all ages were included, and the minimum follow-up required for eligibility was 4 months. Patients were excluded if surgery was not offered for curative intent and preoperative imaging did not demonstrate that gross-total resection was achievable.

There were more complications in the conventional surgery cohort than in the EEA cohort (33.33% vs 14.29%, p = 0.033). There was no significant difference in the EOR between the EEA and conventional surgery cohorts, as demonstrated by comparable rates of positive margins in both groups (5.56% vs 2.38%, respectively). Disease progression (hazard ratio [HR] 0.47, 95% CI 0.17–1.27, p = 0.137) was lower and OS (HR 0.58, 95% CI 0.26–1.29, p = 0.183) was higher in the EEA cohort, but these findings did not reach statistical significance.

The EEA was found to be associated with lower risks of complications than conventional craniofacial surgical approaches. There were no significant differences in OS and progression-free survival between the EEA and conventional surgical cohorts when comparing anatomically matched cohorts of patients with stage T4 sinonasal malignancies and skull base involvement.

扩大内窥镜方法（EEA）越来越多地用于鼻腔恶性肿瘤的明确治疗。在适当选择的病例中，EEA 可提供相似的肿瘤学结果，但与开放手术方法相比，并发症发生率较低。选择偏倚是之前比较 EEA 和开放式手术方法治疗鼻窦恶性肿瘤的研究中报告的一个限制。为了解决这个问题，在这项研究中，作者比较了解剖学匹配的颅底受累局部晚期鼻窦恶性肿瘤（T4 期）患者队列的长期肿瘤学结果。本研究的具体目的是调查 EEA 和开放手术队列之间的切除程度 (EOR)、总生存期 (OS) 和疾病进展。

一组由 42 名患有局部晚期鼻窦恶性肿瘤且颅底受累（T4 期）并通过 EEA 进行手术的患者与一组由 54 名接受开放手术的患者进行解剖学匹配。对 1993 年 9 月至 2020 年 6 月期间接受治疗的 96 名患者进行了回顾性图表审查。根据解剖学标准，该队列中的所有患者均符合 EEA 或开放手术的条件。所有年龄段的患者均纳入其中，符合资格所需的最短随访时间为 4 个月。如果不出于治疗目的而进行手术且术前影像学未证明可以实现大体全切除，则患者被排除在外。

传统手术队列的并发症多于 EEA 队列（33.33% vs 14.29%，p = 0.033）。EEA 组和传统手术组之间的 EOR 没有显着差异，两组的阳性切缘率相当（分别为 5.56% 和 2.38%），这证明了这一点。EEA 队列中的疾病进展（风险比 [HR] 0.47，95% CI 0.17–1.27，p = 0.137）较低，OS（HR 0.58，95% CI 0.26–1.29，p = 0.183）较高，但这些发现未达到统计学显着性。

研究发现，与传统颅面手术方法相比，EEA 的并发症风险较低。当比较解剖学匹配的 T4 期鼻窦恶性肿瘤和颅底受累患者队列时，EEA 和传统手术队列之间的 OS 和无进展生存率没有显着差异。