Management of the neck in paranasal sinus cancers and long-term outcomes

Background Paranasal sinus malignancies are rare and frequently present at an advanced stage. The optimal management of the clinically or radiologically N0 neck remains controversial.Aims/Objective To evaluate cervical lymph node management based on preoperative radiological findings and long-term oncological outcomes in patients with advanced paranasal sinus malignancies.Material and methods Thirty-four patients who underwent surgery for T3 or T4a paranasal sinus malignancies between 2014 and 2020 were retrospectively evaluated. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan–Meier analysis, and survival curves were compared using the log-rank test.Results Twenty-seven patients (79.4%) had T3 and seven (20.6%) had T4a disease. Eight patients (23.5%) had radiologically suspicious cervical lymph nodes and underwent neck dissection; two (25.0%) had pathological nodal metastasis. Cervical recurrence occurred in three patients (8.8%), and 14 (41.2%) experienced local or cervical recurrence. Five-year OS and DFS were 48.6% and 49.4%, respectively. T4a disease was associated with poorer DFS (p < 0.001).Conclusions and significance Cervical nodal involvement was uncommon. Our findings do not provide evidence supporting routine elective neck treatment in radiologically N0 patients. T4a disease was associated with poorer DFS.