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161

ICAR SINONASAL TUMORS

TABLE XVII.A.4 Evidence surrounding patterns of recurrence of JNA.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Reyes et al. 351

Recurrence rates 1. Endoscopic approach had significantly lower rates of recurrence than open approach for all tumor stages 2. Advanced tumors had significantly higher recurrence rates than low-stage tumors

2019 2

Meta-analysis Nine studies of

patients with JNA treated with open versus endoscopic surgical approach ( n = 362)

Szyfter et al. 779

2020 4

Retrospective case series

Patients who

1. GTR 2. Rates of

1. 72% of patients had GTR 2. 28% had residual or recurrent tumor that required reoperation 3. Low-stage tumors had

underwent either open or endoscopic resection of JNA ( n = 71)

residual or recurrent tumor 3. Blood loss

100–400 mL blood loss; advanced tumors had 500–2500 mL

1. 82% of cases were managed endoscopically in the modern cohort versus 8% in historical cohort 2. Significantly less blood loss in modern cohort 3. 9% recurrence rate versus 24% recurrence rate comparing modern to historical cohort Three cases regressed, two cases stayed stable, one case increased at 2.2 mm/year 1. 16.8% of patients had residual disease on follow-up imaging 2. Most common sites of disease were pterygoid canal, base of pterygoid, and pterygopalatine foramen 1. Age < 14 years at diagnosis had significantly higher recurrence rate than age > 14 years (34.7% vs. 8%) 2. Preoperative embolization did not significantly decrease intraoperative blood loss but did increase LOS 12 of 38 patients had postoperative residual disease; eight demonstrate stable disease, four demonstrated progression ranging from 4.1 to 9.2 mm/year patients with residual disease had

Cohen-Cohen et al. 780

1. Surgical

2020 4

Case–control

Patients who

approach

underwent surgical resection of JNA from 2005 to 2019

2. GTR 3.

Intraoperative blood loss

compared to 65 historical cases ( n = 22)

4. Recurrence

Schreiber et al. 791

2018 4

Retrospective case series

Patients with JNA

Natural history of persistent JNA

including six cases of patients with postsurgical persistent JNA ( n = 74)

Liuet al. 794

1. Presence of residual disease 2. Location of residual disease

2018 4

Retrospective case series

Patients with JNA treated with endoscopic

resection ( n = 131)

Pamuk et al. 768

2018 4

Retrospective case series

Patients with JNA underwent endoscopic

1. Disease

recurrence

2.

resection ( n = 48)

Intraoperative blood loss

3. LOS

Rowan et al. 793

1. Proportion of patients with residual disease 2. Natural

2018 4

Retrospective case series

Patients who underwent

endoscopic or combined resection of JNA( n = 38)

history of and management of residual disease

significantly higher UPMC Staging System scores than patients with GTR and no residual disease on interval imaging Abbreviations: GTR, gross total resection; JNA, nasopharyngeal angiofibroma (formerly juvenile nasopharyngeal angiofibroma); LOS, length of stay; UPMC, University of Pittsburgh Medical Center.