(645) Risk-Stratified Outcomes of Endoscopic vs Open Surgery for Esthesioneuroblastoma: A National Cohort (NCDB 2004-2021)

Introduction: Esthesioneuroblastoma (ENB) is rare, and endoscopic resection is increasingly used; whether surgical approach affects peri-operative outcomes and survival across stage is unclear. We compared endoscopic versus open resection overall and importantly, by T stage (T1–2 vs T3–4) to see if staging impacts treatment-specific outcomes.

Methods: Retrospective database study of NCDB ENB cases treated with curative-intent surgery (2004–2021). Surgical approach was categorized as endoscopic versus open using NCDB variables. Outcomes were length of stay (LOS), 30-day readmission, and 90-day mortality. Overall survival analyses required ≥5 years follow-up (2004–2017) and used adjusted Cox models overall and within T1–2 and T3–4 strata; models adjusted for covariates significant on bivariate comparisons between approach groups (sex, tumor grade category, primary site, and AJCC clinical T; pathologic T/stage were included when available).

Results: Endoscopic share among surgical cases rose from 37.5% (2004) to 65.0% (2021), and endoscopic patients more often had clinical T1 disease (37.1% vs 16.7%). Endoscopic resection had fewer prolonged stays (LOS >10 days 12.2% vs 14.0%; p=0.0003) with similar 30-day readmission and 90-day mortality. Overall 5-year survival was similar (open vs endoscopic: HR 1.30, 95% CI 0.63–2.68; p=0.476). In T3–4 disease, open surgery was associated with worse adjusted survival (HR 4.12, 95% CI 1.56–10.90; p=0.004), whereas T1–2 outcomes were comparable (HR 1.31, 95% CI 0.39–4.38; p=0.656).

Conclusions: Endoscopic resection is increasingly adopted and is associated with shorter hospitalization without increased early adverse events. Adjusted survival was similar overall; in stratified analyses, endoscopic approach was associated with improved adjusted survival in T3–4 disease, though residual confounding may remain, while outcomes were comparable for T1–2.