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KUANetal.

TABLE VI.1 Evidence surrounding en bloc versus debulking/piecemeal resection.

Clinical endpoints

Study

Year LOE Study design Study groups

Conclusion

Satoet al. 127

Local recurrence En bloc is not the only surgical technique with sound oncologic results in sinonasal tumor resection

1970 3

Retrospective cohort

“Trimodality protocol” ( n = 57; maxillary debridement, RT, and regional CT) versus en bloc resection with pre or postoperative RT ( n = 97) 41 patients with CFR for advanced SNM; en bloc versus piecemeal resection 34 patients with EEA for sinonasal tumor (27 with definitive resection and seven with debulking) lesions treated with EEA and resected with microdebrider ( n = 32) 20 patients with EEA for SNM divided by resection type (en bloc vs. piecemeal) Anterior skull base advanced SNM treated with preoperative CRT and “organ-preserving” surgical resection adenocarcinoma of the ethmoids treated with surgical debulking and topicalCT 70 patients with 19 patients with

Konig et al. 132

2018 3

Retrospective cohort

Disease-free survival

En bloc resection was associated with improved DFS on univariate but not recursive partition analysis. Debulking surgery was associated with lower survival

deAlmeida et al. 130

1. DFS 2. OS

2014 3

Retrospective cohort

Patel et al. 131

2014 3

Retrospective case series

N/A

Gross and near total resection are feasible with piecemeal resection

Tosun et al. 134

Local recurrence No local recurrence in patients who underwent achieved negative margins after piecemeal resection of the intranasal tumor and tumor base

2014 3

Retrospective cohort

Samant et al. 129

2004 3

Retrospective cohort

OS

Organ-preserving surgery can be utilized even in advanced SNM

Knegt et al. 128

DFS

High DFS can be obtained with surgical debulking and adjuvant treatment.

2001 3

Retrospective cohort

Kilic et al. 135

2017 4

Retrospective database (NCDB) Retrospective case series

1483 patients with sinonasal SCC

1. Margin

No difference in margin positivity between open versus endoscopic approaches En bloc resection may be possible for certain anatomically limited sinonasal tumors

positivity

2. OS

Omura et al. 133

Ability to

2017 4

Eight patients with benign, unilateral sinonasal tumors endoscopically

achieve en bloc resection

resected with wide transseptal exposure

Abbreviations: CRT, chemoradiation therapy; DFS, disease-free survival; EEA, endoscopic endonasal approach; NCDB, National Cancer DataBase; OS, overall survival; SCC, squamous cell carcinoma; SNM, sinonasal malignancy.