Critical Appraisal of Surgical Modalities in Olfactory Neuroblastoma: A Systematic Review

Keywords

esthesioneuroblastoma - surgery - endoscopic - surgery - open - treatment Outcome - neoplasm Recurrence - local

Background: Olfactory neuroblastoma (ONB), a rare malignant tumor of the nasal cavity, poses unique challenges for treatment. Surgical management options include both endoscopic and open approaches, but there is a need to systematically evaluate their comparative effectiveness in terms of outcomes.

Methods: We conducted a systematic review following PRISMA guidelines to identify studies comparing endoscopic and open surgical interventions for olfactory neuroblastoma. A comprehensive literature search was performed using MeSH keywords in prominent databases, including PubMed, Embase, Cochrane, and Web of Science. Data extraction was carried out independently by two reviewers, and findings were synthesized through narrative analysis and comparative assessment.

Results: Our analysis included studies spanning a range of years (2000–2022) and hospital settings. We included a total of 57 studies, encompassing a cohort of 2046 patients who underwent surgical treatment for ONB. Among the participants, 53.9% underwent open surgical approaches, and 35.4% of them were female. The mean follow-up period for patients in the endoscopic approaches cohort was 57.8 months, whereas those who underwent open approaches had a slightly longer follow-up period of 69 months on average. Kadish stages were reported for 788 participants in the endoscopic approach group and 695 participants in the open approach group. Notably, participants with Kadish A/B stages were significantly more prevalent in the endoscopic cohort, with a p-value of <0.05. Conversely, Kadish C/D stages were significantly more common among patients who chose open approaches. When considering specific complications, infections and pneumocephalus were significantly more frequent in the open approach group, with a p-value of 0.02. In terms of survival outcomes, the overall survival rate was notably higher in the endoscopic approach group, standing at 93%, in contrast to the 68% observed in the open approach group. Moreover, disease-free survival also favored the endoscopic approach, with rates of 94% and 58% for endoscopic and open approaches, respectively. Mortality was significantly higher in the open approach group, with a p-value of 0.008. Local and regional recurrences were more frequent in the open approach group.

Conclusion: This systematic review offers a comprehensive assessment of endoscopic and open surgical approaches for ONB treatment. Findings shed light on the nuanced differences between these interventions and their impact on patient outcomes. We consider that the significant difference in overall survival, disease-free survival, mortality and recurrences is related to higher Kadish stages in the open approaches cohort. As esthesioneuroblastoma remains a rare and complex disease, this review aims to inform clinical decision-making and guide future research efforts in optimizing treatment strategies.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024