Frontiers in surgery · 2026
Application and prognostic analysis of endoscopic sinus surgery combined with multidisciplinary team management in rhino-orbito-cerebral mucormycosis.
СтатьяНазвание и аннотация: Перевод в очереди
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Liu Tingting, Zhao Qiuliang
Аннотация
OBJECTIVE: To evaluate the clinical value of endoscopic sinus surgery (ESS) combined with a multidisciplinary team (MDT) approach in rhino-orbito-cerebral mucormycosis (ROCM) and identify independent prognostic factors.
METHODS: This retrospective cohort study enrolled 22 consecutive patients with ROCM managed by a standardized MDT protocol between January 2020 and June 2024.Clinical data covering endoscopic surgical strategies and cross-specialty MDT collaboration were systematically extracted. Univariate chi-square analysis and multivariate binary logistic regression were performed to screen mortality predictors. Kaplan-Meier survival curves with log-rank tests were generated for survival comparisons.
RESULTS: The cohort included 14 males and 8 females with a mean age of 58.6 ± 10.3 years. Diabetes mellitus was the dominant underlying comorbidity (18/22, 81.8%), among whom six patients presented with diabetic ketoacidosis (27.3%). 18 patients (81.8%) received endoscopic debridement, and 10 of these surgical patients (55.6%) underwent concurrent endoscopic optic nerve decompression. Histopathology confirmed characteristic broad, aseptate, right-angle branching hyphae; Rhizopus species were isolated from 6 patients via fungal culture and metagenomic next-generation sequencing (mNGS). At the predefined 6-month primary follow-up endpoint, 12 patients (54.5%) met composite remission criteria, while 10 patients (45.5%) died of ROCM-related complications. Multivariate logistic regression identified intracranial extension as the sole independent risk factor for mortality (OR = 28.5, 95% CI: 2.1-387.4, P = 0.011). Early surgery performed within 72 h of symptom onset showed a trend toward reduced mortality (OR = 0.18, 95% CI: 0.02-1.52, P = 0.11), and well-controlled glycemia (HbA1c ≤ 7.0%) exhibited a protective tendency (OR = 0.25, 95% CI: 0.03-2.08, P = 0.20), yet neither variable reached statistical significance after multivariate adjustment. Kaplan-Meier survival analysis revealed significantly longer survival among patients without intracranial fungal invasion (log-rank P < 0.001).
CONCLUSION: Endoscopic sinus surgery serves as the core intervention to eradicate primary sinonasal lesions in ROCM. Structured MDT collaboration optimizes surgical timing and standardized comorbidity management. Early precise endoscopic debridement combined with standardized long-term antifungal therapy substantially improves clinical outcomes. Timely endoscopic debridement within 72 h and strict glycemic control represent critical modifiable factors to reduce mortality risk.
METHODS: This retrospective cohort study enrolled 22 consecutive patients with ROCM managed by a standardized MDT protocol between January 2020 and June 2024.Clinical data covering endoscopic surgical strategies and cross-specialty MDT collaboration were systematically extracted. Univariate chi-square analysis and multivariate binary logistic regression were performed to screen mortality predictors. Kaplan-Meier survival curves with log-rank tests were generated for survival comparisons.
RESULTS: The cohort included 14 males and 8 females with a mean age of 58.6 ± 10.3 years. Diabetes mellitus was the dominant underlying comorbidity (18/22, 81.8%), among whom six patients presented with diabetic ketoacidosis (27.3%). 18 patients (81.8%) received endoscopic debridement, and 10 of these surgical patients (55.6%) underwent concurrent endoscopic optic nerve decompression. Histopathology confirmed characteristic broad, aseptate, right-angle branching hyphae; Rhizopus species were isolated from 6 patients via fungal culture and metagenomic next-generation sequencing (mNGS). At the predefined 6-month primary follow-up endpoint, 12 patients (54.5%) met composite remission criteria, while 10 patients (45.5%) died of ROCM-related complications. Multivariate logistic regression identified intracranial extension as the sole independent risk factor for mortality (OR = 28.5, 95% CI: 2.1-387.4, P = 0.011). Early surgery performed within 72 h of symptom onset showed a trend toward reduced mortality (OR = 0.18, 95% CI: 0.02-1.52, P = 0.11), and well-controlled glycemia (HbA1c ≤ 7.0%) exhibited a protective tendency (OR = 0.25, 95% CI: 0.03-2.08, P = 0.20), yet neither variable reached statistical significance after multivariate adjustment. Kaplan-Meier survival analysis revealed significantly longer survival among patients without intracranial fungal invasion (log-rank P < 0.001).
CONCLUSION: Endoscopic sinus surgery serves as the core intervention to eradicate primary sinonasal lesions in ROCM. Structured MDT collaboration optimizes surgical timing and standardized comorbidity management. Early precise endoscopic debridement combined with standardized long-term antifungal therapy substantially improves clinical outcomes. Timely endoscopic debridement within 72 h and strict glycemic control represent critical modifiable factors to reduce mortality risk.