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Sinonasal quality of life outcomes after minimally invasive resection of sinonasal and skull-base tumors

Authors

  • Brian R. Harrow MSII,

    1. University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas, TX
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  • Pete S. Batra MD, FACS

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX
    2. Comprehensive Skull Base Program, Clinical Center for Neurosciences, University of Texas Southwestern Medical Center, Dallas, TX
    • Correspondence to: Pete S. Batra, MD, FACS, Comprehensive Skull Base Program, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390; e-mail: pete.batra@utsouthwestern.edu

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  • Potential conflict of interest: P.S.B.: research grants (ARS, Medtronic); consultant (Medtronic). B.R.H.: none.

  • Presented orally at the COSM ARS Spring Meeting on April 12-13, 2013, Orlando, FL.

Abstract

Background

Minimally invasive endoscopic resection (MIER) has emerged as the standard for surgical management of benign and malignant sinonasal and skull-base neoplasms. The objective of the present study was to assess sinonasal quality of life (QOL) and to analyze factors that impact symptomatology after surgery.

Methods

This single-institution observational cohort study was performed on 94 patients over a 3-year period.

Results

The mean age was 55.2 years, with male:female ratio of 1.5:1. Benign and malignant tumors were observed in 48% and 52% of patients, respectively. The cohort's mean preoperative 20-item Sino-Nasal Outcomes Test score (SNOT-20) was 1.27, decreasing to 0.91 (p = 0.002) at 6 months postoperatively. Patients with benign neoplasms had a lower mean preoperative SNOT-20 score of 1.11 that decreased to 0.58 (p = 0.002), whereas patients with malignant tumors had a higher mean preoperative SNOT-20 score of 1.27, decreasing to 1.03 (p = 0.134) at 6 months postoperatively. The SNOT-20 scores for females improved 0.53 (p = 0.002) compared to 0.23 (p = 0.154) for males at 6 months. Statistically significant sinonasal QOL improvement was noted in nonsmokers (0.62, p = 0.0006), patients with no prior radiation or chemotherapy (0.59, p = 0.0029), and patients with no prior surgery (0.51, p = 0.0012). Multiple variable regression analysis demonstrated that the 2 strongest predictors for lack of SNOT-20 improvement were previous history of smoking (p < 0.05) and prior radiation and/or chemotherapy (p < 0.01) (R2 = 0.24).

Conclusion

MIER results in overall improvement in SNOT-20 scores, with greater change being noted in females and in patients with benign tumors. Prior smoking and chemoradiation strongly predict decreased improvement in sinonasal QOL after surgery.

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