title: Propensity score analysis of endoscopic and open approaches to malignant paranasal and anterior skull base tumor outcomes.
abstract: Malignant sinonasal and skull base tumors are now being resected using an endoscopic technique, but there has been controversy regarding the oncologic safety of this approach. Various studies have compared the outcomes from endoscopic surgery to those from open techniques; however, all have been limited by substantial differences in the patient populations receiving each approach. In this study we compare outcomes of open and endoscopic techniques and use propensity score matching to control for these differences in the patient populations.
  
  
  
  Retrospective cohort study including all patients > 18 years old receiving primary surgery for malignant sinonasal or skull base tumors at our institution from 2002 to 2013.
  
  
  
  One hundred twenty-four patients met criteria; 82 received endoscopic-only surgery, and 42 had an open component to their approach. There was an 86% 3-year overall survival and a 74% disease-free survival. Without controlling for differences in the groups, the endoscopic patients fared significantly better in survival, recurrence rates, wound infections, and length of hospital stay. When using propensity score matching to account for patient comorbidities and tumor size, there were no significant differences in any outcomes except length of the hospital stay. A multivariate regression analysis yielded the same results.
  
  
  
  In this study, endoscopic surgery was shown to be a safe alternative to the open technique, even when controlling for the favorable patient and tumor characteristics in endoscopic patients. This is the first study to account for these differences with a rigorous statistical methodology.
  
  
  
  4. Laryngoscope, 126:1724-1729, 2016.
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Douglas
authors.initials: D
authors.lastname: Farquhar
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Luke
authors.initials: L
authors.lastname: Kim
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Douglas
authors.initials: D
authors.lastname: Worrall
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of Arizona Medical Center, Tucson, Arizona, U.S.A.
authors.forename: Alexander
authors.initials: A
authors.lastname: Chiu
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: John Y K
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Sammy
authors.initials: S
authors.lastname: Khalili
authors.affiliation: Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Sean
authors.initials: S
authors.lastname: Grady
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Bert W
authors.initials: BW
authors.lastname: O'Malley
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David W
authors.initials: DW
authors.lastname: Kennedy
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newman
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: James N
authors.initials: JN
authors.lastname: Palmer
authors.affiliation: Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nithin D
authors.initials: ND
authors.lastname: Adappa
mesh_terms: D015331:Cohort Studies; D004724:Endoscopy; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010255:Paranasal Sinus Neoplasms / Q000601:surgery*; D057216:Propensity Score; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Skull base tumor; endoscopic surgery; propensity score; sinonasal malignancy