1 Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
2 Norris Medical Library, University of Southern California, Los Angeles, California.
Am J Rhinol Allergy. 2019 Mar;33(2):162-169. doi: 10.1177/1945892418822637. Epub 2019 Jan 7.
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.
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.
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).
Based on the available literature, an endoscopic approach for SNM resection has survival outcomes that are similar or greater compared to an open approach.
传统上，经鼻内镜手术（ER）一直是治疗鼻腔鼻窦黑色素瘤（SNM）的金标准。然而，最近内镜切除术（ER）已成为一种替代手术方法。本研究旨在比较 SNM 的开放切除术（OR）和内镜切除术（ER）的生存结果。
我们对 PubMed、Embase、Cochrane 图书馆、Web of Science、ClinicalTrials.gov 和 Google Scholar 进行了文献检索。两名审查员独立筛选比较 SNM 的 OR 和 ER 生存结果的原始研究。系统地收集了研究设计、患者人口统计学、结果和证据水平的数据。使用纽卡斯尔-渥太华量表（NOS）进行质量评估。使用随机效应模型对总生存率和无病生存率进行荟萃分析。
最初的搜索产生了 2078 篇摘要，其中 9 项队列研究被纳入，来自 6 个不同国家的共 510 名患者。使用 NOS 的所有纳入研究的平均质量为 7.7 星。6/7 项研究报告称，接受 ER 与 OR 的患者的 SNM 分期没有差异。ER 组的总生存率高于 OR 组（风险比 [HR]：0.68，95%置信区间 [CI]：0.49-0.95）。两组之间无病生存率无显著差异（HR：0.59，95% CI：0.28-1.25）。
根据现有文献，与开放方法相比，内镜方法切除 SNM 的生存结果相似或更好。
