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Clinical research
Available online 6 October 2021
Endoscopic versus open surgery in patients with malignant sinonasal tumours and brain invasion. A case series study
Cirugía endoscópica vs. cirugía abierta en pacientes con neoplasias nasosinusales malignas con invasión cerebral. Estudio de serie de casos
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Joel Caballero-Garcíaa,
Corresponding author
joelcaballero.ns@gmail.com

Corresponding author.
, Elizabeth Bárbara Cuétara Lugob, Juan Jesús Lence-Antaa, Nélido Gonzáles Fernándeza, Adolfo Hidalgo-Gonzálesb, Grisel Kindelán-Agustína
a Instituto Nacional de Oncología y Radiobiología, La Habana, Cuba
b Centro Nacional de Cirugía de Mínimo Acceso, La Habana, Cuba
Received 10 January 2021. Accepted 18 April 2021
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Figures (5)
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Tables (5)
Table 1. Comparison of confounding variables between treated and untreated before and after propensity score matching.
Table 2. Comparison of surgical approaches according to perioperative variables.
Table 3. Percentage of complications according to surgical approach used.
Table 4. Functional status according to the Karnofsky Performance Scale.
Table 5. Distribution of perioperative costs.
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Abstract
Objectives

To determine the safety, effectiveness and perioperative costs of endonasal endoscopic approach in brain invasive malignant sinonsal tumours patients.

Materials and methods

This was a case series bidirectional study; that included 30 brain invasive malignant sinonsal tumours patients treated by endonasal endoscopic approach (2015–2017) and 53 by open surgery (2010–2015). Propensity score matching was used to compensate the prognostic factors; in a sample of 50 patients (25 per group). Primary response variables was local control and 3-years overall survival. Perioperative cost variables were analyzed.

Results

A number of 50 patients were included after matching (25 in each therapeutic group). The age average was 55 years and male proportion was 62%. Squamous cell carcinoma and grade II lesions were the most represented in the sample. Endonasal endoscopic approach reduced surgical time in 1 h 20 min, transfusion needs in 5.5 fold and hospitalization in 19 days; in comparison with open technique. Oncologic control based on surgical free margins, local control, overall survival and progression free survival after three years was higher when the resection was performed endoscopically. Functional status was enhanced and complications diminished by using endoscopic approach. Saving was estimated in $7 355.18 per patient.

Conclusions

Endonasal endoscopic approach represents a safe, effective and economic procedure in selected patients with malignant sinonasal tumors and brain invasion.

Keywords:
Malignant sinonasal tumours
Brain invasion
Endonasal endoscopic approach
Craniofacial surgery
Propensity score matching
Resumen
Objetivos

Evaluar la efectividad, la seguridad y los costos perioperatorios del abordaje endonasal endoscópico en pacientes con tumores nasosinusales malignos con invasión cerebral.

Pacientes y método

Se realizó un estudio observacional de serie de casos. Se compararon 30 pacientes con tumores nasosinusales malignos e invasión cerebral operados (2015–2017) mediante abordaje endoscópico con una serie histórica de 53 casos operados (2010–2015) mediante cirugía abierta. Se utilizó el método de emparejamiento por puntaje de propensión para controlar el efecto de factores pronósticos. Las variables de respuesta primaria fueron el control local y la supervivencia global a los tres años. Se analizaron variables de costo perioperatorio.

Resultados

Después del emparejamiento se identificaron 50 pacientes (25 en cada grupo terapéutico) con edad promedio de 55 años, 62% de sexo masculino. Predominó el carcinoma de células escamosas y la invasión cerebral grado II. El control local de la enfermedad a los tres años, la supervivencia global y libre de progresión fueron superiores en el abordaje endoscópico. El abordaje endoscópico redujo el tiempo quirúrgico en 1 hora y 20 minutos y la estadía hospitalaria en 19 días en comparación con la cirugía abierta. El abordaje endoscópico mejoró la independencia funcional y redujo las complicaciones. El ahorro promedio estimado con el abordaje endoscópico fue de aproximadamente $7.355,18 por paciente.

Conclusiones

El abordaje endonasal endoscópico constituye un procedimiento seguro, efectivo y más económico en los pacientes con neoplasias nasosinusales malignas e invasión cerebral.

Palabras clave:
Tumores nasosinusales malignos
Invasión cerebral
Abordaje endonasal endoscópico
Cirugía craneofacial
Emparejamiento por puntaje de propensión

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