# Forty-Year Long-Term Outcome After Endoscopic and Open Surgery for Esthesioneuroblastoma in Consideration of Prognostic Factors

## TL;DR

This study compares long-term outcomes of endoscopic and open surgery for esthesioneuroblastoma over 40 years, finding both methods effective when used appropriately.

## Contribution

The study provides the first long-term comparison of endoscopic and open surgery outcomes for esthesioneuroblastoma over four decades.

## Key findings

- Endoscopic surgery showed comparable long-term survival rates to open surgery for esthesioneuroblastoma.
- Advanced-stage tumors were more commonly treated with open surgery.
- Endoscopic surgery had higher disease-free survival rates compared to open surgery.

## Abstract

Therapy in esthesioneuroblastoma (ENB) involves complete surgical resection with or without adjuvant therapy. Complete resection can be achieved by various surgical methods including various open approaches (OpS) and endoscopic-controlled surgery (ES). During the last two decades minimal invasive endoscopic-controlled surgery was introduced and established. OpS and ES were compared in various reports and ES proved to be of equal value at least for smaller tumors. However, data comparing long-term results after OpS and ES are missing. In this manuscript, we compared results and survival after OpS and ES over four decades. We found in our report that ES, when the limitations of this approach are respected, can be performed like OpS with an acceptable outcome also in the long-term course. Our publication confirms that successful management of ENB is possible by less invasive surgery.

Background: The objective of this study was to compare results after endoscopic (ES) and open surgery (OpS) for esthesioneuroblastoma over a 40-year period. Methods: In a retrospective study, patients who had undergone ES and OpS for esthesioneuroblastoma with curative intent were included. The following outcome parameters were compared after ES and OpS: epidemiologic, clinical (including known tumor classifications), histopathologic, therapeutic (resection state, adjuvant therapy), and development of recurrences. Crude survival and Kaplan–Meier 10 y, 20 y, and 35 y actuarial survival were calculated. Results: Between 1981 and 2021, 15 patients were operated with ES and 28 with OpS. Advanced-stage tumors were significantly more often treated using OpS. For all other parameters, there were no other significant differences between ES and OpS. After ES, the 35 y OS, DSS, and DFS were 48.1%, 100%, and 55.9%, respectively. After OpS, they were 40.5%, 77.5%, and 35.3%. Conclusions: ES is an effective approach in esthesioneuroblastoma, even in the long-term course over decades, if the appropriate indication compared to OpS is respected.