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Published on: June 20, 2018
Outcomes in Orbit-Sparing Versus Orbit-Sacrificing Surgery for Sinonasal Malignancies With Orbital Involvement: A
Claire Jing-Wen Tan1, Brian Sheng Yep Yeo1, Manish Warrier1
1Yong Loo Lin School of Medicine, National University of Singapore Singapore Singapore.
Background:
Sinonasal malignancies with orbital involvement may be managed with orbit-sacrificing or orbit-preserving surgical approaches, with a recent shift towards orbital preservation to reduce postoperative morbidity while maintaining oncological success. The current clinical data on the most optimal approach for managing such locally advanced tumours remains inconclusive.
Methods:
PubMed, Embase, and SCOPUS were searched from inception to 12 June 2024 for longitudinal studies investigating oncological and functional outcomes in sinonasal malignancies with orbital involvement managed with orbit-sacrificing vs. orbit-preserving surgery. Two independent authors selected relevant articles, extracted data, assessed bias using the Newcastle-Ottawa Scale and evaluated quality of evidence following the Grading of Recommendations, Assessment, Development and Evaluations framework. Random-effects meta-analysis was performed to synthesise pooled oncological outcomes, while descriptive reviews were performed for functional outcomes.
Results:
This systematic review and meta-analysis of 12 studies and 758 participants found that the 5-year overall survival rate of patients managed with orbit-preserving surgery (55%, 95% CI: 0.32-0.76) was comparable to that in patients managed with orbit-sacrificing surgery (53%, 95% CI: 0.34-0.70). The 5-year recurrence-free survival rate was significantly higher in patients managed with orbit-preserving surgical intervention (64%, 95% CI: 0.44-0.80), compared to those with orbit-sacrificing surgery (48%, 95% CI: 0.13-0.84). Descriptive review showed good functional outcomes in patients managed with orbit-preserving surgery.
Conclusion:
Orbit-preserving surgery in selected cases of sinonasal malignancies with orbital involvement is oncologically safe and can allow for the maintenance of a functionally useful eye. Greater number of large-scale, robust studies are required to further evaluate the outcomes in tumours with different characteristics.
Insights
Orbit-preserving surgery for sinonasal malignancies with orbital involvement offers comparable survival rates and improved recurrence-free survival. This approach maintains a functionally useful eye, demonstrating oncological safety in selected cases.
Area of Science:
- Oncology
- Surgical Oncology
- Ophthalmology
Background:
- Sinonasal malignancies with orbital involvement present complex management challenges.
- Surgical options include orbit-sacrificing and orbit-preserving approaches.
- There is a clinical trend towards orbital preservation to minimize morbidity while ensuring oncological control.
Purpose of the Study:
- To systematically review and meta-analyze oncological and functional outcomes of orbit-sacrificing versus orbit-preserving surgery for sinonasal malignancies with orbital involvement.
- To compare the efficacy and safety of these two surgical strategies.
Main Methods:
- A systematic literature search was conducted on PubMed, Embase, and SCOPUS.
- Longitudinal studies comparing orbit-sacrificing and orbit-preserving surgery were included.
- Random-effects meta-analysis for oncological outcomes and descriptive review for functional outcomes were performed.
Main Results:
- The 5-year overall survival rates were comparable between orbit-preserving (55%) and orbit-sacrificing (53%) surgery.
- Orbit-preserving surgery demonstrated a significantly higher 5-year recurrence-free survival rate (64%) compared to orbit-sacrificing surgery (48%).
- Good functional outcomes, including the preservation of a useful eye, were observed with orbit-preserving surgery.
Conclusions:
- Orbit-preserving surgery is oncologically safe for selected sinonasal malignancies with orbital involvement.
- This approach can preserve ocular function, leading to better quality of life.
- Further large-scale studies are needed to evaluate outcomes across different tumor characteristics.