Early oncologic outcomes of endoscope-assisted total maxillectomy for maxillary sinus squamous cell carcinoma: A comparative study with conventional surgery.

OBJECTIVES

This study aimed to compare oncologic and surgical outcomes between conventional and endoscope-assisted total maxillectomy for primary maxillary sinus squamous cell carcinoma, a technically demanding procedure, particularly with respect to posterior and medial margin control.

MATERIALS AND

METHODS

This retrospective cohort study was conducted at two tertiary referral centers between February 2018 and September 2024. Twenty-four patients with primary maxillary sinus squamous cell carcinoma who underwent total maxillectomy with curative intent were included. Twelve patients underwent conventional open surgery, and twelve underwent endoscope-assisted total maxillectomy. Surgical margin status, recurrence patterns, postoperative pterygoid plate length, and survival outcomes were compared between groups. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method.

RESULTS

All patients underwent curative-intent resection. Positive surgical margins were observed in two patients (16.7%) in the conventional group and in none in the endoscope-assisted group. The endoscope-assisted group was significantly associated with improved early recurrence control compared with the conventional group (2-year RFS, 100% vs 50% [95% CI, 0.21-0.74]; log-rank p = 0.02). Firth-corrected Cox regression analysis confirmed this association (HR 0.17, 95% CI 0.018-0.788, p = 0.022). OS data are presented descriptively due to the limited number of events (2-year OS, 100% vs 91.7% [95% CI, 53.9-98.8]). The postoperative residual length of the pterygoid plate was significantly shorter in the endoscope-assisted group, supporting the technical feasibility and precision of posterior resection.

CONCLUSION

Endoscope-assisted total maxillectomy was associated with improved early recurrence control within the observation period and more precise posterior resection compared with the conventional approach. Although limited by its retrospective design and small sample size, this study provides proof-of-concept evidence supporting the feasibility and oncologic safety of endoscope-assisted total maxillectomy and warrants further validation through multi-institutional studies.