xRead - Nasal Obstruction (September 2024) Full Articles

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B Patient and demographic factors Age, sex, ethnicity, and socioeconomic status, as well as tobacco and alcohol use, were not associated with a higher risk of surgical complications in some series. 14,2054 On the other hand, a large retrospective cohort found a positive association between the presence of comorbidities and surgical complications, but the severity of comorbidities was not rated. 2056 Another review analyzed demographic and patient factors in patients undergoing surgery for SNM. They used the Charlson comorbidity index to strat ify preoperative comorbidities and Clavien–Dindo grade to specify the level of complications, and no statistical association was found between these variables. 2054 Bash jawish et al. evaluated the relationship between age and surgical complications, and concludes that there was no significant difference in the incidence of complications between elderly and nonelderly patients undergoing resec tion of nasal tumors. 2061 The same conclusion about age as a risk factor for surgical complications was reported by Lepera et al. when analyzing 203 patients who underwent endoscopic resection of sinonasal and anterior skull base tumors. 370 There is no consensus in the literature on demo graphic factors, comorbidities, and their impact on risk of surgical complications, so the authors suggest that a care ful and individualized evaluation is always recommended, considering the risks and benefits of surgical treatment. 2062 Aggregate grade of evidence : C (Level 3: three studies; Level 4: one study) C Types of approach Open CFR was traditionally the gold standard treatment for sinonasal tumors. In the last three decades, the use of endoscopic techniques, either alone or in combina tion with open approaches, has become more common. 6 The endoscopic approach is widely used for treatment of benign tumors and, in carefully selected cases, shown to be a safe option with similar oncological results in the management of malignant tumors. 280 A systematic review and meta-analysis by Lu et al. pooled 900 patients under going open or endoscopic surgery for treatment of SNM and concluded that there was no significant difference in major complication rate between the two approaches (RR 0.68; p = 0.12). 313 In contrast, a systematic review and meta-analysis published by Meccariello et al. that included 39 studies of 1732 patients with sinonasal adenocarcino mas treated with endoscopic techniques showed a different result. 259 They concluded that endoscopic and endoscopic assisted approaches were associated with lower rates of major complications (6.6% and 25.9%, respectively) when compared to open approaches (36.4%; p < 0.01).

Aggregate grade of evidence : C (Level 2: two studies; Level 3: two studies)

D Salvage surgery Salvage (or rescue) surgery is considered in patients with a tumor recurrence, more commonly indicated in case of malignant tumors with curative intent. Most studies that address risk factors for surgical complications are focused on primary surgery. Kaplan et al., in a case series that analyzed 42 patients underwent salvage surgery, found an overall complication rate of 28.6%. 417 The most frequent complications were CSF leak ( n = 4), ORN ( n = 2), and epidural abscess ( n = 2). One patient had a carotid blowout and one patient required orbital decompression. Teshima et al. analyzed the outcomes of 48 patients undergoing surgery for malignancy involving the skull base, of which 30 were salvage cases. 2063 They concluded that patients undergoing RT or CRT had a significantly higher risk of developing severe intraoperative complications when compared to those who did not have prior treatment. Simi larly, anterolateral skull base resection was associated with a higher rate of complications. Patients undergoing salvage surgery are at higher risk of surgical complications, longer hospital stays, and higher mortality rates compared with those undergoing primary surgery. 378 Aggregate grade of evidence : C (Level 3: two studies; Level 4: one study) Table XXIX.1 summarizes evidence surrounding risk factors for surgical complications in sinonasal tumors. QOL is broadly defined by the WHO as an “individ ual’s perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns.” 2064 Survey instruments developed to assess QOL may examine elements of general overall health related QOL, disease-specific QOL, and symptom-specific QOL. There is no single instrument developed specifically for all sinonasal tumors, although many questionnaires exist that may be appropriate in certain clinical situa tions. For example, sinonasal tumors may involve the anterior skull base, and several instruments exist to assess QOL in patients undergoing skull base surgery. 2065–2067 Additionally, disease-specific QOL instruments have been developed for NPC. Ultimately, the choice of specific instruments depends on tumor pathology, treatment type, and goals of the assessment. XXX QUALITY OF LIFE INSTRUMENTS