xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

to baseline QOL impact. 2089,2090,2093 As such, Harrow et al. and Derousseau et al. reported the most significant improvement in these subdomains postoperatively. 2089,2090 Glicksman et al. demonstrated significant improvement in all subdomains of the SNOT-22 in their cohort, although the rhinologic and sleep components appeared to account for the largest component of improvement in SNOT-22. 2093 Importantly, Harrow and Batra note that the mean dif ference in 40% of their benign tumor cohort met the minimal clinically important difference (MCID) for the SNOT-20 questionnaire. 2089 The mean difference of total SNOT-22 scores in the Glicksman et al. 7 cohort met the MCID of the SNOT-22, but the authors did not specif ically comment on the percentage of patients who met the MCID. Of note, the MCID of these questionnaires is calculated for CRS patients and not tumor patients, and it is important to make a distinction between statistical significance and clinical significance particularly when investigating QOL. Three other studies only reported post operative data, but suggested that postoperative SNOT-20 and SNOT-22 scores were comparable to those of normal healthy controls. 2085,2091,2092 Comparison of QOL improvements between benign and malignant sinonasal tumors has also been investi gated. Current data suggest that patients with benign sinonasal neoplasms experience significant sinonasal QOL improvement following minimally invasive endo scopic resection. 2089,2090,2093 Consistently across these studies, patients with malignant tumors tended to have higher baseline SNOT-20 or SNOT-22 scores, and also tended to have less consistent QOL improvement after surgery. Improvement in SNOT-20 in patients with malignant tumors in Harrow and Batra’s series failed to reach statistical significance at any time point postoper atively. In fact, only the sleep subdomain demonstrated a significant improvement at 6 months postoperatively. Similarly, Derousseau et al. did not report any significant improvement in SNOT-20 among patients with malignant tumors. 2090 However, within the sleep and psychological subdomain, a significant reduction in SNOT-20 score was noted at 1 and 2 years postoperatively in the malignant tumor group. Contrary to the prior two studies, however, Glicksman et al. recorded significant improvements in overall SNOT-22 within both their benign and malignant tumor cohorts at all time points. 2093 Similarly, all SNOT-22 subdomain scores demonstrated significant improvement in both groups. The authors report that the overall tra jectory of improvement was similar between the groups, although the malignant group maintained relatively 2 Differences between benign and malignant neoplasms

higher scores at all time intervals. 2093 Deckard et al. noted that postoperative sinonasal QOL was significantly better in benign tumor patients according to the anterior skull base questionnaire and SNOT-20. 2085 Together, these findings suggest that patients with benign tumors tend to have less severe QOL impacts at baseline. Additionally, benign tumor patients consistently experience statisti cally significant QOL improvement after surgery, while improvements in those with malignant tumors are less predictable, and may be impacted by the requirement for adjuvant therapy. Expanded endoscopic approaches to sinonasal tumors have allowed surgeons to extirpate progressively more advanced tumors through a purely endoscopic approach. How these expanded approaches affect disease outcomes, namely, recurrence rate, complications, and survival, has been extensively investigated (Table XXXI.A.1). However, evaluation of QOL using validated metrics is less com monly reported. In their series of 37 patients with sinonasal IP, van Samkar and Georgalas did not find any differ ence in SNOT-22 scores among patients who required medial maxillectomy for tumor resection compared to those who underwent standard endoscopic surgical tech niques for tumor removal. 2091 Additionally, Bertazzoni et al. reviewed their series of 48 patients who under went the Sturmann–Canfield procedure (removal of the entire medial wall of the maxillary sinus, sectioning of the nasolacrimal duct, and enlargement of the pyriform aperture laterally up to the infraorbital foramen, sim ilar to the modified endoscopic Denker technique) for resection of maxillary sinus IP. 2092,2095 The study only included postoperative data, but the mean SNOT-22 score in this series was 5.94. The mean follow-up in this series was 66.3 months, though the authors do not comment on the time point at which the SNOT-22 questionnaire was filled out by patients. Although there is no control group in this series, the low mean SNOT-22 score suggests that this expanded approach may not significantly impact overall sinonasal QOL. Finally, Lin and Chen reported their series of 21 patients who underwent the endoscopic prelacrimal approach for a variety of benign maxillary sinus lesions. 2094 Median postoperative SNOT-22 scores were 8.0 in those with papillomas and 13.5 in patients with non-papilloma pathology. Within the papilloma group, despite a reduction in overall SNOT-22 from 17.5 preopera tively to 8.0 postoperatively, statistical significance was not met. However, with mean total SNOT-22 scores of a control population reported to be 12.0, these data would suggest that the expanded prelacrimal approach for benign maxil- 3 Morbidity related to extended maxillary approaches