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Outcome results of endoscopic vs craniofacial resection of sinonasal malignancies: a systematic review and pooled‐data analysis
Author(s) -
Higgins Thomas S.,
Thorp Brian,
Rawlings Brad A.,
Han Joseph K.
Publication year - 2011
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.20051
Subject(s) - medicine , esthesioneuroblastoma , medline , systematic review , malignancy , guideline , surgery , nasal cavity , pathology , political science , law
Background Endoscopic approaches of sinonasal malignancies are now being described. This study aims to conduct a systematic review with a pooled‐data analysis to compare outcomes of endoscopic vs craniofacial resection of sinonasal malignancies. Methods A search was conducted of MEDLINE (1966–2008), EMBASE (1980–2008), Cochrane Central Register of Clinical Trials (CENTRAL), Cochrane Database of Systematic Reviews, clinicaltrials.gov, and The National Guideline Clearinghouse databases and supplemented by references in retrieved articles. All authors used a detailed list of inclusion and exclusion criteria to determine articles eligible for final inclusion. The authors extracted data regarding study criteria appraisal, sinonasal malignancy characteristics, survival outcomes, and recurrence. Kaplan‐Meier survival and locoregional control rates were calculated and compared using the log‐rank test. Results Of the 2314 citations reviewed, the search yielded 15 case series with individual data on 226 patients. The most common malignancies were esthesioneuroblastoma (47%), adenocarcinoma (24%), and undifferentiated carcinoma (22%). The overall 5‐year survival rate for the sample was 56.5% (standard error [SE] ± 3.8). Because of the paucity of data with endoscopic resection of high‐stage malignancies, the outcome results were highly variable and no useful comparison could be made. Among low‐stage malignancies (T1–2 or Kadish A‐B), the endoscopic and open approaches demonstrated no statistically significant difference in outcome results. The 5‐year overall survival was 87.4% (SE ± 5.3) in the endoscopic group vs 76.8% (SE ± 8.3) for open approaches ( p = 0.351); disease‐specific survival was 94.7% (SE ± 3.7) vs 87.7% (SE ± 6.7; p = 0.258); and locoregional control rate was 89.5% (SE ± 5.0) vs 77.2% (SE ± 10.4; p = 0.251). Conclusion Transnasal endoscopic resection appears to be a reasonable alternative to craniofacial resection in the management of low‐stage sinonasal malignancies. © 2011 ARS‐AAOA, LLC.