Open Versus Endoscopic Approach for Sinonasal Melanoma: A Systematic Review and Meta-analysis

Abstract

Background Open resection (OR) of sinonasal mucosal melanoma (SNM) traditionally has been the gold standard for treatment. However, endoscopic resection (ER) has recently become a surgical alternative. The aim of this study was to compare survival outcomes between OR and ER of SNM. Methods A literature search encompassing PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, and Google Scholar was performed. Two reviewers independently screened for original studies comparing survival outcomes between OR and ER for SNM. Data were systematically collected on study design, patient demographics, outcomes, and level of evidence. Quality assessment was performed using the Newcastle-Ottawa scale (NOS). Meta-analysis of overall survival and disease-free survival was performed using random-effects models. Results The initial search yielded 2078 abstracts, of which 9 cohort studies were included for a total of 510 patients from 6 different countries. The average quality of all included studies using the NOS was 7.7 stars. Six out of 7 studies reported no differences in the stages of SNM between patients receiving ER versus OR. Overall survival was longer in the ER group versus OR group (hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.49–0.95). There was no significant difference in disease-free survival between groups (HR: 0.59, 95% CI: 0.28–1.25). Conclusion Based on the available literature, an endoscopic approach for SNM resection has survival outcomes that are similar or greater compared to an open approach.

Surgical Margin Status and Survival Following Resection of Sinonasal Mucosal Melanoma

“…Similar findings were reported by Lundberg et al and Lombardi et al in their assessments of survival outcomes in 58 patients 32,33 . A meta‐analysis of 2,078 abstracts totaling 510 patients performed by Hur et al similarly demonstrated that there was no significant difference in disease‐free survival between the two surgical approaches 30 . We found no significant difference in obtaining NSM between the endoscopic approach and the open approach (Table 2).…”

“…Both have been shown to be efficacious treatment modalities that provide great clinical benefit. While open resection has been the gold standard approach, endoscopic surgery has gained popularity because of its potential for increased precision and visualization and improved cosmesis 29,30 . Despite this, there is reluctance among surgeons to widely utilize this surgical modality because of the potential difficulty with adequately identifying tumor margins 31 .…”

Molecular Biomarkers in Sinonasal Cancers: New Frontiers in Diagnosis and Treatment

“…Recently, immunotherapy has shown promising results in selected cases, both in neoadjuvant and adjuvant settings, especially in terms of decreased systemic spread of disease. Hur et al reported the use of ipilimumab, a monoclonal antibody targeting CTLA-4, in a cohort of metastatic MM, obtaining a 12.5% response rate, improved up to 23% when combined with the anti-PD1 therapy, nivolumab [ 77 ]. The concept of sequential immune checkpoint blockade with two inhibitors, such as anti-PD1 and anti-CTLA-4, merits further study to determine which patients are most likely to benefit, especially due to the potential escape oncogenic mechanisms intrinsic to MM biologic nature.…”

Surgical Management of Sinonasal Cancers: A Comprehensive Review

“…Endoscopic surgery for the resection of sinonasal mucosal melanomas has been shown to be effective and is associated with similar oncologic outcomes compared to more invasive surgery [125][126][127]. Some studies have found better overall survival [119,128,129], and improved local control [128,130] in patients treated endoscopically compared to open craniofacial surgery, but these results remain controversial and may reflect a selection bias or may be related to the lower morbidity associated with this surgery [119]. Resection with clear resection margins does not provide a survival benefit in mucosal melanoma [117].…”