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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 2016 December;66(4):120-7
Outcomes of endoscopic approaches to tumors of the sinonasal cavity and skull base
Jorge TORALES 1, 2, Cristobal LANGDON 2, 3, 4, Alfonso SANTAMARÍA 2, 3, Joaquim ENSEÑAT 1, 2, Isam ALOBID 2, 3, 4
1 Neurosurgery Department, University of Barcelona, Barcelona, Spain; 2 Rhinology Unit and Smell Clinic, ENT Department, IDIBAPS, Barcelona, Spain; 3 Skull Base Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain; 4 Clinical and Experimental Respiratory Immunology, IDIBAPS, Barcelona, Spain
INTRODUCTION: Since the last decade endoscopic endonasal approaches (EEA) for sinonasal and skull base tumors (SNST) are being described as valid alternative for open approaches. This study aimed at reviewing the literature extensively and pooling data-on oncological outcome.
EVIDENCE ACQUISITION: A systematic search of Pubmed (from 1970 to 2015) was carried out. The authors extracted data regarding patients demographic, sinonasal malignancy characteristics, treatment, follow-up, survival outcome and recurrence.
EVIDENCE SYNTHESIS: Twenty-four articles using an endoscopic or endoscopic-assisted approach were identified and included. The mean follow-up was 38.1 months. The mean age of the included subjects was 59.3 y (±4.3), 30.4% females. In 202 cases, a recurrence was described at the last follow-up visit. The most frequent complication associated with the endoscopic approach was CSF-leak (43 cases), followed by local infection (12 cases) and perioperative death (2 cases). The 5-year overall survival (OS) was 72.5 % and disease-free survival (DFS) was 75.8%. Surgery was described as the best single modality treatment, but chemotherapy and irradiation were important as adjuvant treatments in extensive and aggressive disease. The presence of neck metastases was identified as a poor prognostic factor.
CONCLUSIONS: This study, containing 1309 retrospective cases of SNST, confirmed a good overall survival. The data suggested that the optimal treatment consists of surgery, with irradiation and/or chemotherapy as adjuvant treatment options. Neck metastasis and advanced local disease were poor prognostic factors and merit aggressive treatment with multimodality therapy.