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

Abstract

OBJECTIVE\nTo compare the efficacy of endoscopic and open resection of sinonasal malignancies.\n\n\nMETHODS\nThe 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.\n\n\nRESULTS\nOf 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\u202f=\u202f0.84 [95% CI: 0.65-1.07], p\u202f=\u202f0.16; random effects analysis). Pooled analysis with Cox regression revealed signifcant differences in overall survival (HR\u202f=\u202f0.568 [95%CI:0.380-0.849], p\u202f=\u202f0.006) and disease-free survival (HR\u202f=\u202f0.628 [95%CI:0.424-0.929], p\u202f=\u202f0.02) between endoscopic and open approaches.\n\n\nCONCLUSION\nThe aggregated evidence suggests the survival outcome of endoscopic resection is comparable or greater than that of open resection of sinonasal malignancies.