xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.23262, Wiley Online Library on [02/01/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

79

ICAR SINONASAL TUMORS

TABLE X.2 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Songet al. 250

1. Less blood less and shorter operation time in endoscopic groups 2. Endoscopic approaches for advanced ONB showed comparable survival results compared to open approaches 1. Increased OS in EEA patients compared to open approach, regardless of Kadish stage 2. EEA reduced hospital LOS No significant difference in major complications between open and EEA

1. DFS 2. Complications 3. Operation time

2012 3

Retrospective cohort

35 ONB patients OpenCFR( n = 12) Endoscopic CFR with craniotomy ( n = 11) Transnasal endoscopic resection without craniotomy ( n = 5)

Barinsky et al. 254

2021 4

Retrospective database (NCDB)

533 ONB patients Open ( n = 267) EEA( n = 257)

1. LOS 2. OS

Wertz et al. 248

Major

2018 4

Retrospective case series

41 ONB patients EEA( n = 6) Combined open and endoscopic ( n = 1) Open approach ( n = 34)

complications

Abbreviations: CN, cranioendoscopic; EEA, endoscopic endonasal approach; GTR, gross total resection; LRC, locoregional control; NCDB, National Cancer DataBase; ONB, olfactory neuroblastoma; OS, overall survival; PFS, progression-free survival; RFS, recurrence-free survival; TCA, transcranial approach.

F Overall outcomes Numerous studies have shown comparable outcomes between EEA and open approaches when adjusting for tumor type, stage, margins, and other prognostic factors. 14,182,264,265,280–299 Husain et al. queried the NCDB and compared a cohort of 2292 cases, of which 645 under went EEA and 1647 open approach. 288 The 5-year OS for the open versus EEA groups was 59.6% and 60.8%, respectively ( p = 0.106). The mean LOS for the EEA was significantly lower than for the open approach (3.13 vs. 5.52 days, p < 0.05). The 30-day readmission rate was not different between groups ( p = 0.804). There were no significant differences in mortality rates. Rutland et al. reviewed their 10-year experience with EEA versus transcranial approach for skull base malignan cies. This single-institution retrospective review consisted of 30 open approaches versus 30 EEA. 282 There were no significant differences in age, sex, T stage, or Kadish stage between groups. GTR for open approach (76.7%) and EEA (90.0%) was not significantly different ( p = 0.30). Blood loss was 247% higher and LOS was 251% longer in open approaches, which persisted after controlling for age, sex, T stage, tumor volume, and histopathology. Local recur rence rates were higher after open approaches (41.4% vs. 13.3%). The 5-year OS was higher for the EEA group (71.3% vs. 26.7%). Beswick et al. performed a prospective multicenter cohort study comparing complications rates between EEA and open approaches for SNM treated primarily with

postoperative RT and/or immunotherapy. Almutuawa et al. in 2020 presented a retrospective cohort study on the outcomes of 20 SNMMs comparing 10 open approaches to 10 EEA. 277 The EEA group had overall improved median (31.67 vs. 11.17 months) and 1-year survival (80% vs. 30%, p = 0.032). Multivariate analysis adjusting for potential confounders showed an increased risk of mortality for the open approach compared to EEA. Farber et al. compared EEA and open approaches by querying the NCDB for nonmetastatic SNMM initially managed with definitive surgery. 278 Cohorts of 240 EEA and 240 open approaches were matched 1:1 on all signif icant demographic and clinicopathologic variables. The 1-, 3-, and 5-year OS rates were comparable ( p > 0.05) for EEA (78.1%, 50.5%, and 38%, respectively) and open approach (77.4%, 43.6%, and 34.7%, respectively). There were absolute differences in LOS (1.4 vs. 3.0 days), 30 day readmission rate (4.8% vs. 0%), and 30-day (0% vs. 1.3%) and 90-day (0.7% vs. 3.2%) mortality for the EEA versus open groups, though only LOS and readmissions reached significance. Hur et al. also conducted a system atic review showing that 5-year OS was significantly longer in patients undergoing EEA versus open approach, but there was no difference in DFS. 279 More than 85% of the studies reviewed reported no difference in the average dis ease stage between the EEA and open groups, suggesting the results may apply to tumors of all stages. Despite the overall poor prognosis of SNMM, EEA appears to offer sim ilar survival rates to open approaches in level 4 studies (Table X.5).

Made with FlippingBook - professional solution for displaying marketing and sales documents online