Outcomes in Orbit-Sparing Versus Orbit-Sacrificing Surgery for Sinonasal Malignancies With Orbital Involvement: A Systematic Review and Meta-Analysis.

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.