Surgical Outcomes of Endoscopic Versus Open Resection for Primary Sinonasal Malignancy

A Meta-analysis

Victor M. Lu, Krishnan Ravindran, Kevin Phan, Jamie J. Van Gompel, Timothy R. Smith, Angela M. Donaldson, Alfredo Quinones-Hinojosa, Rania A. Mekary, Kaisorn L. Chaichana

Research output: Contribution to journalReview article

Abstract

Background: Endoscopic resection (ER) for uncommon sinonasal malignancies (SNMs) has been reported to confer superior surgical outcomes compared to open resection (OR) based on indirect comparisons of limited evidence. Objective: The aim of this study was to pool all direct comparative studies in the literature to validate this potential superior association. Methods: Systematic searches of 7 electronic databases from their inception to April 2019 were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 1001 articles identified for screening. Outcomes of interest were pooled as risk ratios (RRs) and mean difference (MD) and analyzed using a random-effects model. Results: There were 10 studies included in this meta-analysis, with 900 SNM patients in total where ER and OR were utilized in 399 (44%) and 501 (56%) cases, respectively. Compared to OR, random-effects (RE) modeling indicated ER resulted in statistically comparable complications (RR = 0.68; P-effect =.12) and recurrence (RR = 0.84; P-effect =.35). ER was associated with significantly shorter length of stay (LOS) compared to OR (MD = −2.9 days; P-effect <.01). Conclusions: The use of ER to manage SNM was associated with significantly favorable reduction in LOS compared to OR. However, with respect to other surgical outcomes and recurrence, the current literature does not indicate either ER or OR as statistically superior. Therefore, until greater validation of these associations can be proven, expectations that ER for SNMs confers superior surgical outcomes compared to OR should be tempered.

Original languageEnglish (US)
JournalAmerican Journal of Rhinology and Allergy
DOIs
StatePublished - Jan 1 2019

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Meta-Analysis
Odds Ratio
Length of Stay
Neoplasms
Recurrence
Databases
Guidelines

Keywords

  • cancer
  • complications
  • endoscopic
  • open
  • recurrence
  • resection
  • sinonasal cavity
  • sinonasal malignancy
  • squamous
  • tumor

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

Cite this

Surgical Outcomes of Endoscopic Versus Open Resection for Primary Sinonasal Malignancy : A Meta-analysis. / Lu, Victor M.; Ravindran, Krishnan; Phan, Kevin; Van Gompel, Jamie J.; Smith, Timothy R.; Donaldson, Angela M.; Quinones-Hinojosa, Alfredo; Mekary, Rania A.; Chaichana, Kaisorn L.

In: American Journal of Rhinology and Allergy, 01.01.2019.

Research output: Contribution to journalReview article

Lu, Victor M. ; Ravindran, Krishnan ; Phan, Kevin ; Van Gompel, Jamie J. ; Smith, Timothy R. ; Donaldson, Angela M. ; Quinones-Hinojosa, Alfredo ; Mekary, Rania A. ; Chaichana, Kaisorn L. / Surgical Outcomes of Endoscopic Versus Open Resection for Primary Sinonasal Malignancy : A Meta-analysis. In: American Journal of Rhinology and Allergy. 2019.
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title = "Surgical Outcomes of Endoscopic Versus Open Resection for Primary Sinonasal Malignancy: A Meta-analysis",
abstract = "Background: Endoscopic resection (ER) for uncommon sinonasal malignancies (SNMs) has been reported to confer superior surgical outcomes compared to open resection (OR) based on indirect comparisons of limited evidence. Objective: The aim of this study was to pool all direct comparative studies in the literature to validate this potential superior association. Methods: Systematic searches of 7 electronic databases from their inception to April 2019 were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 1001 articles identified for screening. Outcomes of interest were pooled as risk ratios (RRs) and mean difference (MD) and analyzed using a random-effects model. Results: There were 10 studies included in this meta-analysis, with 900 SNM patients in total where ER and OR were utilized in 399 (44{\%}) and 501 (56{\%}) cases, respectively. Compared to OR, random-effects (RE) modeling indicated ER resulted in statistically comparable complications (RR = 0.68; P-effect =.12) and recurrence (RR = 0.84; P-effect =.35). ER was associated with significantly shorter length of stay (LOS) compared to OR (MD = −2.9 days; P-effect <.01). Conclusions: The use of ER to manage SNM was associated with significantly favorable reduction in LOS compared to OR. However, with respect to other surgical outcomes and recurrence, the current literature does not indicate either ER or OR as statistically superior. Therefore, until greater validation of these associations can be proven, expectations that ER for SNMs confers superior surgical outcomes compared to OR should be tempered.",
keywords = "cancer, complications, endoscopic, open, recurrence, resection, sinonasal cavity, sinonasal malignancy, squamous, tumor",
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T1 - Surgical Outcomes of Endoscopic Versus Open Resection for Primary Sinonasal Malignancy

T2 - A Meta-analysis

AU - Lu, Victor M.

AU - Ravindran, Krishnan

AU - Phan, Kevin

AU - Van Gompel, Jamie J.

AU - Smith, Timothy R.

AU - Donaldson, Angela M.

AU - Quinones-Hinojosa, Alfredo

AU - Mekary, Rania A.

AU - Chaichana, Kaisorn L.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Endoscopic resection (ER) for uncommon sinonasal malignancies (SNMs) has been reported to confer superior surgical outcomes compared to open resection (OR) based on indirect comparisons of limited evidence. Objective: The aim of this study was to pool all direct comparative studies in the literature to validate this potential superior association. Methods: Systematic searches of 7 electronic databases from their inception to April 2019 were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 1001 articles identified for screening. Outcomes of interest were pooled as risk ratios (RRs) and mean difference (MD) and analyzed using a random-effects model. Results: There were 10 studies included in this meta-analysis, with 900 SNM patients in total where ER and OR were utilized in 399 (44%) and 501 (56%) cases, respectively. Compared to OR, random-effects (RE) modeling indicated ER resulted in statistically comparable complications (RR = 0.68; P-effect =.12) and recurrence (RR = 0.84; P-effect =.35). ER was associated with significantly shorter length of stay (LOS) compared to OR (MD = −2.9 days; P-effect <.01). Conclusions: The use of ER to manage SNM was associated with significantly favorable reduction in LOS compared to OR. However, with respect to other surgical outcomes and recurrence, the current literature does not indicate either ER or OR as statistically superior. Therefore, until greater validation of these associations can be proven, expectations that ER for SNMs confers superior surgical outcomes compared to OR should be tempered.

AB - Background: Endoscopic resection (ER) for uncommon sinonasal malignancies (SNMs) has been reported to confer superior surgical outcomes compared to open resection (OR) based on indirect comparisons of limited evidence. Objective: The aim of this study was to pool all direct comparative studies in the literature to validate this potential superior association. Methods: Systematic searches of 7 electronic databases from their inception to April 2019 were conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 1001 articles identified for screening. Outcomes of interest were pooled as risk ratios (RRs) and mean difference (MD) and analyzed using a random-effects model. Results: There were 10 studies included in this meta-analysis, with 900 SNM patients in total where ER and OR were utilized in 399 (44%) and 501 (56%) cases, respectively. Compared to OR, random-effects (RE) modeling indicated ER resulted in statistically comparable complications (RR = 0.68; P-effect =.12) and recurrence (RR = 0.84; P-effect =.35). ER was associated with significantly shorter length of stay (LOS) compared to OR (MD = −2.9 days; P-effect <.01). Conclusions: The use of ER to manage SNM was associated with significantly favorable reduction in LOS compared to OR. However, with respect to other surgical outcomes and recurrence, the current literature does not indicate either ER or OR as statistically superior. Therefore, until greater validation of these associations can be proven, expectations that ER for SNMs confers superior surgical outcomes compared to OR should be tempered.

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KW - complications

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KW - recurrence

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KW - sinonasal cavity

KW - sinonasal malignancy

KW - squamous

KW - tumor

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DO - 10.1177/1945892419856976

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