xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

TABLE X.6 (Continued)

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Nicolai et al. 316

2008 4 a

DSS

5-year DSS was lower in open approach than EEA

Retrospective cohort

184 patients EEA( n = 134) Open ( n = 50)

Buchmann et al. 295

2006 4

Retrospective case series

63 patients Open ( n = 27) Endoscopic ( n = 36)

1. Disease-free status 2. Mortality

Endoscopic techniques are comparable to open techniques in terms of disease-free status and mortality EEA had better OS and fewer complications

2006 4 a

Castelnuovo et al. 139

1. OS 2. Complications

Retrospective cohort

67 patients EEA( n = 49) Open ( n = 18)

Abbreviations: CFR, craniofacial resection; DFS, disease-free survival; DSS, disease-specific survival; EEA, endoscopic endonasal approach; GTR, gross total resection; LOS, length of stay; NCDB, National Cancer DataBase; OS, overall survival; PFS, progression-free survival; RFS, recurrence-free survival; SNM, sinonasal malignancy. a LOE downgraded for lack of controlling for confounding factors.

G Approaches to the maxillary sinus The maxillary sinus is the largest of the paranasal sinuses and is the primary site of a number of malignant and benign tumors, with much of the tumor literature in this area focusing on IP. Historically, approaching maxillary sinus tumors utilized open approaches (e.g., Caldwell Luc) to gain wide access and good visibility for resec tion. These open approaches often resulted in significant morbidity, including pain, facial scarring, dental and/or facial numbness, paresthesia, and devitalization of den tition. In the last several decades, there have been many advances in endoscopic transnasal techniques to approach the maxillary sinus, with improved endoscopic access, faster healing, and lesser morbidity. This review exam ines the primary literature on extended maxillary sinus approaches and compares the clinical outcomes across a variety of maxillary surgical techniques. Multiple heterogenous studies compare open to endoscopic-assisted and pure endoscopic surgical tech niques for maxillary tumor resection (Table X.7). While the granular surgical approaches and extent of tumor involvement varied among publications, the studies that compared endoscopic to open approaches generally found similar rates of recurrence for maxillary IP after both techniques. Moreover, Durucu et al. and Kim et al. demonstrated that endoscopic and endoscopic-assisted techniques, as compared to open approaches, had lower rates of complications and shorter LOS after surgery. 300,301 A number of case series were published on the use of isolated maxillary approaches for IP and other tumors involving the maxillary sinus (Table X.8). Recurrence rates

Value

Current conclusions are primarily based on limited data. Many studies have small sample sizes and cannot adjust for tumor stage, patient comorbidities, covariates, or tumor type. The above recommendations are based on data quality, evaluation of surgical outcomes, outcomes grouped by tumor stage, and systematic reviews that demonstrate consistent findings across many studies. Most studies include a heterogenous grouping of SNM, preventing clear recommendations for approach by tumor type or by tumor location. Larger prospective studies are needed to develop clear recommendations for surgical approach, particularly in late-stage tumors where data on endoscopic approach outcomes are lacking. endoscopic surgery should be considered the first-line surgical approach to reduce morbidity and recovery times while achieving similar oncologic outcomes to open surgery. In advanced-stage tumors (such as T3–4), endoscopic SNM surgery approaches should be considered on a case-by-case basis according to the tumor location, surgeon experience, patient preference, tumor grade, and with consideration of the risk–benefit ratio of alternative treatment options.

judgments

Policy level Recommendation for EEA for low-stage tumors. Option for EEA for high-stage tumors. Intervention In most low-stage sinonasal tumors,