Endoscopic Endonasal Resection of Advanced Stage T3/T4 Sinonasal Malignancies Involving Skull Base: Monocentric Single-Surgeon Study (2020-2024)

Abstract Objective This study aims to evaluate the outcomes of endoscopic endonasal resection in patients with advanced-stage T3/T4 sinonasal malignancies involving the skull base, analyzing surgical efficacy, challenges, and implications for future clinical practice. Materials and Methods A retrospective analysis was conducted on a monocentric single-surgeon cohort of 16 patients (mean age 60.7 ± 10.5 years) diagnosed with T3/T4 sinonasal malignancies affecting subsites of the skull-base region between 2020 and 2024. All the patients underwent primary radical endoscopic endonasal resection at the Department of ENT, Head & Neck Surgery, University Hospital “Tsaritsa loanna – lSUL”, Medical University – Sofia, followed by adjuvant radiotherapy. Results The cohort consisted of predominantly male patients (56.25%), with squamous cell carcinoma being the most common histological type (81.25%). Outcomes indicated a recurrence-free survival rate of 81.3% at a median follow-up of 30 months. Intraoperative findings revealed complexities in distinguishable tumor invasion, especially concerning critical anatomical structures, necessitating meticulous surgical techniques. Conclusions Endoscopic endonasal resection demonstrates potential efficacy in managing advanced sinonasal malignancies, with a favorable recurrence-free survival rate underscoring its role as a viable surgical option. The study emphasizes the importance of individualized treatment strategies and the need for multidisciplinary collaboration to optimize patient care in this challenging clinical scenario.