title: Endoscopic Resection of Sinonasal Malignancy: A Systematic Review and Meta-analysis.
abstract: The use of endoscopic approaches for sinonasal malignancy resection has increased, but survival data are limited secondary to disease rarity and new surgical technique. Here we present a systematic review and meta-analysis of endoscopic endonasal resection of sinonasal malignancy.
  
  
  
  MEDLINE, PubMed Central, NCBI Bookshelf, Cochrane Library, clinicaltrials.gov, National Guideline Clearinghouse.
  
  
  
  PRISMA/MOOSE guidelines were followed. MeSH terms were "endoscopic" AND ("esthesioneuroblastoma" OR "sinonasal adenocarcinoma" OR "squamous cell carcinoma" OR "sinonasal undifferentiated carcinoma"). For studies in which individual-level data were available, results were obtained by direct pooling. For studies in which only summary Kaplan-Meier curves were available, numerical data were extracted, traced, and aggregated by fitting a Weibull model.
  
  
  
  Of 320 studies identified, 35 case series were included (n = 952 patients), with 15 studies analyzed via aggregate modeling and 20 studies analyzed via direct pooling. Two- and 5-year survival rates for patients in aggregate modeling were 87.5% and 72.3%, respectively (mean follow-up: 32.9 months). Two- and 5-year survival for patients in direct pooling were 85.8% and 83.5%, respectively (mean follow-up: 43.0 ± 19.5 months). Significant overall survival difference was found between low- and high-grade cancers (P = .015) but not between low- and high-stage cancers (P = .79).
  
  
  
  Overall 2- and 5-year survival rates are comparable and sometimes greater than those from open craniofacial resection. Survival rates significantly differ by cancer grade but not stage. Journals and investigators should be encouraged to publish retrospective and prospective case series with staged survival updates based on established guidelines.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA rrawal@unch.unc.edu.
authors.forename: Rounak B
authors.initials: RB
authors.lastname: Rawal
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Farzal
authors.affiliation: Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Jerome J
authors.initials: JJ
authors.lastname: Federspiel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Satyan B
authors.initials: SB
authors.lastname: Sreenath
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Thorp
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Zanation
mesh_terms: D004724:Endoscopy / Q000379:methods*; D006801:Humans; D010255:Paranasal Sinus Neoplasms / Q000601:surgery*; D015996:Survival Rate
keywords: endoscopic; meta-analysis; sinonasal malignancy; systematic review