目的：肠型腺癌（ITAC）是一种罕见的鼻腔鼻窦恶性肿瘤。治疗需要多学科的方法，手术选择包括经鼻内镜入路（EEA）和外部手术（EXTS）。这里,我们提供单中心长期随访的术后和生存结果.
方法：我们报告了1998年至2018年间接受EEA（n=40）或EXTS（n=52）治疗的92例ITAC患者的长期随访。生存估计,比较两种手术方式的术后并发症和住院时间.
结果：基线特征相似。更多的T4b肿瘤（16%），随后更多的肿瘤侵袭（39%），与EEA相比，接受EXTS的患者存在(3%和18%，分别)。未发现Barnes组织学亚型的差异。与EXTS相比，接受EEA的患者术后住院时间较短（4天和7天）。使用EEA与改善疾病特异性生存率相关（DSS；11.4年对4.4年；HREEA=0.53），尤其是T3-4a肿瘤患者（11.4年对3.0年；HREEA=0.41）。T3-4期患者，肿瘤侵袭，手术切缘阳性,粘液或混合组织学，术后住院时间延长显示局部无复发，无病,总的来说,和DSS。
结论：局部晚期ITAC的长期随访表明，与EXTS相比，EEA切除与改善的DSS相关。特别是T3-4肿瘤。两种治疗方式在围手术期和术后并发症方面没有观察到显著差异。尽管接受EEA的患者的住院时间短于接受EXTS治疗的患者。这些结果证实，在可手术的鼻窦ITAC病例中，EEA应仍然是首选的手术方法。
OBJECTIVE: Intestinal-type adenocarcinoma (ITAC) is a rare sinonasal malignancy. Curative treatment requires multidisciplinary approach, with surgical options consist of the endonasal endoscopic approach (EEA) and external surgery (EXTS). Here, we provide the post-operative and survival results from a single-center long-term follow-up.
METHODS: We report long-term follow-up of 92 ITAC cases treated between 1998 and 2018, treated with EEA (n = 40) or EXTS (n = 52). Survival estimates, post-operative complications and duration of hospitalization were compared between surgical modalities.
RESULTS: Baseline characteristics were similar. A higher number of T4b tumors (16%), and subsequently more tumoral invasion (39%), was present in patients undergoing EXTS compared to EEA (3% and 18%, respectively). No difference in Barnes histology subtypes was noticed. Patients undergoing EEA had a shorter post-operative hospitalization stay versus EXTS (4 versus 7 days). Use of EEA was associated to improved disease-specific survival (DSS; 11.4 versus 4.4 years; HREEA = 0.53), especially for patients with T3-4a tumors (11.4 versus 3.0 years; HREEA = 0.41). Patients with T3-4 stage, tumoral invasion, positive surgical margins, mucinous or mixed histology, and prolonged post-operative hospital stay showed poor local relapse-free, disease-free, overall, and DSS.
CONCLUSIONS: Long-term follow-up in locally advanced ITAC demonstrates that resection by EEA is correlated with improved DSS compared to EXTS, especially for T3-4 tumors. No significant differences between both treatment modalities was observed regarding per- and post-operative complications, although hospitalization in patients undergoing EEA was shorter than for patients treated with EXTS. These results confirm that EEA should remain the preferred surgical procedure in operable cases of sinonasal ITAC.
