Table 6_Endoscopic surgery versus various open approaches in esthesioneuroblastoma: a systematic review of the literature.docx

ObjectiveEsthesioneuroblastoma (ENB) is treated using several open surgery (OpS) methods, with or without endoscopic assistance ( ± E-ass) or endoscopic surgery (ES). This systematic review compared the results with various approaches using OpS ± E-ass and ES.
Data sourcesA systematic PubMed/Medline search was conducted for the period 1990–2023.
Review methodsKeywords were “esthesioneuroblastoma” or “olfactory neuroblastoma” and “surgery,” “surgical,” “resection,” “approach,” “open,” and “endoscopic.” Studies/case series and case reports were included. Results with OpS ± E-ass (stratified into various approaches) were compared with ES results. Parameters assessed were follow-up period, frequencies of advanced tumor stages, Hyams grade III–IV tumors, negative margins/gross total resection, postoperative complication rates, preoperative/postoperative radiation therapy/chemotherapy, primary tumor progression, and frequency of/time to first recurrence.
ResultsA total of 88 studies/case series or single cases/case reports (SC/CR) with results after OpS ± E-ass (850 cases) and 84 with results after ES (584 cases) were included. Compared with OpS ± E-ass, after ES, the average follow-up was significantly shorter (p=0.048) and mean crude disease-free survival (DFS) significantly better (studies/case series, p=0.0001; SC/CR, p=0.001). Compared with OPS ± E-ass, after ES, significantly fewer advanced tumors were treated (studies/case series, p=0.0001; SC/CR, p=0.001); negative margins were significantly less frequent (studies/case series, p=0.009); surgical complications were less frequent (studies/case series, p=0.022); less radiation therapy (studies/case series, p=0.043) and/or chemotherapy (SC/CR, p=0.022) was performed; and recurrences were noted significantly less often (studies/case series, p=0.0001; SC/CR, p=0.034). Among OpS ± E-ass, craniofacial resection ± E-ass showed most significant differences from ES.
ConclusionsThese data support that ES can be regarded as the surgical method of first choice in less advanced ENB but may also be a good choice in carefully selected advanced ENB.

研究背景：嗅神经母细胞瘤（Esthesioneuroblastoma, ENB）的临床治疗可采用多种开放手术（open surgery, OpS）方式，可联合或不联合内镜辅助（endoscopic assistance, ±E-ass），亦可直接采用内镜手术（endoscopic surgery, ES）。本项系统综述对比了采用OpS±E-ass各类术式与ES的治疗结局。

数据来源：1990年至2023年期间，针对PubMed/Medline数据库开展了系统性文献检索。

综述方法：检索关键词设置为“嗅神经母细胞瘤（esthesioneuroblastoma/olfactory neuroblastoma）”、“手术”、“外科”、“切除术”、“术式入路”、“开放手术”及“内镜手术”。纳入研究、病例系列及病例报告。将采用OpS±E-ass（按不同术式分层）的治疗结局与ES的治疗结局进行对比。本次研究评估的结局指标包括：随访时长、晚期肿瘤分期占比、Hyams Ⅲ~Ⅳ级肿瘤占比、切缘阴性/肉眼全切率、术后并发症发生率、术前/术后放疗/化疗情况、原发肿瘤进展情况，以及首次复发的频率与复发时间。

研究结果：最终纳入88项采用OpS±E-ass的研究/病例系列或单病例/病例报告（single cases/case reports, SC/CR），共涉及850例患者；另有84项采用ES的研究/病例系列或单病例/病例报告，共涉及584例患者。与OpS±E-ass组相比，ES组的平均随访时长显著更短（p=0.048），而粗算无病生存期（disease-free survival, DFS）显著更优（研究/病例系列：p=0.0001；单病例/病例报告：p=0.001）。与OpS±E-ass组相比，ES组收治的晚期肿瘤患者占比显著更低（研究/病例系列：p=0.0001；单病例/病例报告：p=0.001）；切缘阴性率显著更低（研究/病例系列：p=0.009）；手术并发症发生率更低（研究/病例系列：p=0.022）；放疗（研究/病例系列：p=0.043）和/或化疗（单病例/病例报告：p=0.022）的实施比例更低；肿瘤复发率显著更低（研究/病例系列：p=0.0001；单病例/病例报告：p=0.034）。在OpS±E-ass各类术式中，颅面切除术联合/不联合内镜辅助的术式与ES的差异最为显著。

研究结论：本研究数据支持，对于低分期ENB，ES可作为首选手术方式；对于经严格筛选的高分期ENB患者，ES亦可作为较佳选择。