Outcomes of endoscopic and open resection of sinonasal malignancies: a systematic review and meta-analysis

Abstract

Objective:

To compare the efficacy of endoscopic and open resection of sinonasal malignancies.

Methods:

The search was performed using PubMed (1950–2020), Embase (1974–2020), the Cochrane library, and the website clinicaltrials.gov. The hazard ratio, HR, 95% confidence interval, CI, of the rates of overall survival and disease-free survival and the demographic characteristics of the included studies were extracted and analyzed. Pooled analysis was conducted with the studies’ individual patient data, using log-rank test, Kaplan-Meier survival, and Cox regression analysis.

Results:

Of 1939 articles retrieved, 23 articles were included. Overall, 1373 cases were incorporated into the final analysis, 653 (47.56%) of which underwent the surgery through an endoscopic approach, whereas 720 (52.44%) cases utilized the open approach. The overall survival was comparable between endoscopic and open resection (HR = 0.84 [95% CI: 0.65–1.07], p = 0.16; random effects analysis). Pooled analysis with Cox regression revealed significant differences in overall survival (HR = 0.568 [95%CI:0.380-0.849], p = 0.006) and disease-free survival (HR = 0.628 [95%CI:0.424-0.929], p = 0.02) between endoscopic and open approaches.

Conclusion:

The aggregated evidence suggests the survival outcome of endoscopic resection is comparable or greater than that of open resection of sinonasal malignancies.

KEYWORDS
Meta-analysis; Paranasal sinus neoplasms; Cancer of head and neck; Minimally invasive surgery; Surgical procedures

HIGHLIGHTS

The overall survival rate of the endoscopic resection group was comparable with the open resection group.

The disease-free survival rate of the endoscopic resection group was higher than the open resection group.

The surgery approaches, the adjuvant therapy, the histopathology, and the T-stage have independent effects on the survival outcomes.