Comparison of Outcomes for Open versus Endoscopic Approaches for Esthesioneuroblastoma: A Systematic Review and Individual Patient-Level Pooled Analysis
Bibliographic record
Abstract
Background: Esthesioneuroblastoma (ENB) is a rare, malignant tumor originating from the olfactory epithelium of the nasal cavity. Traditionally, surgical resection has involved a combination of transcranial and/or transfacial approaches; however, recently, purely endoscopic approaches have been adopted. Herein, we compare perioperative and oncologic outcomes for these approaches with a systematic review and pooled analysis. Objective: This study aims to compare the published outcomes for open, endoscopic, and endoscopic-assisted (combined) surgical approaches for ENB. Methods: A systematic review was performed using MEDLINE, EMBASE, Cochrane, and CINAHL (2000–2014) on patients receiving surgical treatment for ENB. Studies were included if they contained five or more patients and reported at least one outcome of interest. Search strategies were conducted in duplicate and differences were resolved by consensus. Outcomes of interest included perioperative complications and oncologic outcomes. Results: A total of 42 studies including 668 patients were identified. Overall, 453 patients underwent open surgery, 177 underwent endoscopic surgery, and 38 underwent a combined approach. No difference was detected in the average duration of follow-up ( p = 0.17). 11.1, 9.1, and 8.7% of patients developed a CSF leak in the open, endoscopic, and combined groups ( p = 0.84), respectively. Intracranial complications occurred in 23.8, 10.0, and 13.8% of patients in the open, endoscopic, and combined groups ( p = 0.02), respectively. Significant differences were observed for crude rates of local ( p < 0.00001), regional ( p = 0.04), and distant recurrence ( p < 0.001). Rates of local, regional, and distant recurrence were 33.3, 14.3, and 7.2%,repectively, in the open surgery group, 13.4, 5.9, and 0%,repectively, in the endoscopic group, and 8.3, 11.1, 16.7%,repectively, in the combined group. Significant differences were also detected in the rates of mortality due to ENB ( p < 0.0001) and other causes ( p = 0.04). In the open group, 15.7% of patients died of ENB and 4.9% died of other causes; in the endoscopic group, there were no deaths; in the combined group, 5.6% died of ENB and 2.8% died of other causes. Pooled time-to-event analysis is being conducted to evaluate patient-level outcomes. Conclusion: Preliminary comparison of outcomes for surgically treated ENB demonstrates favorable perioperative and oncologic control rates for the endoscopic and combined approaches. Longer follow-up and comparison of more homogenous populations is needed to accurately compare these approaches.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.026 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.020 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".