Oncological and Functional Outcomes after Endoscopic Resection OF Esthesioneuroblastoma: Systematic Review and Single-Arm Meta-Analysis

Background: Endoscopic surgery is increasingly used for esthesioneuroblastoma (ENB), offering oncologic control with potentially reduced morbidity versus open craniofacial approaches. Clarifying long-term cancer control and functional impact of endoscopic resection remains important, particularly given recognized prognostic roles of Kadish stage and Hyams grade. Methods: We performed a PRISMA-guided systematic review and single-arm meta-analysis (PubMed, Embase, Scopus; inception–August 2025). Eligible studies enrolled ≥5 ENB patients undergoing endoscopic or predominantly endoscopic resection and reported oncologic or functional outcomes. Two reviewers independently screened/extracted data and assessed study quality (MINORS/JBI for case series; ROBINS-I for comparative cohorts). For oncologic endpoints (overall survival [OS], disease-free/progression-free survival [DFS/PFS], recurrence, disease-specific mortality, complications), pooled proportions were calculated with a random-effects (DerSimonian–Laird) model using logit transformation and continuity correction; heterogeneity was summarized by I 2 and τ 2 . Because functional outcomes (quality of life [QoL], length of stay [LOS]) were heterogeneously reported and frequently lacked dispersion statistics, they were synthesized narratively per SWiM guidance. We prespecified stage/grade and treatment factors as potential effect modifiers but did not perform formal subgroup pooling due to inconsistent reporting across studies. Results: Twenty-seven studies comprising 890 patients met inclusion. Pooled 5-year OS was 87% (95% CI 80–93), and 5-year DFS 82% (95% CI 73–91), with substantial between-study heterogeneity consistent with differences in stage/grade mix, adjuvant therapy, and extent of resection. Recurrence occurred in roughly 1 in 5 patients, typically within ~2 years; pooled disease-specific mortality was ~3%. Endoscopic surgery demonstrated a favorable safety profile; across reporting series, cerebrospinal fluid leak ~5% and postoperative meningitis ~3%. Functional outcomes were less consistently captured. LOS was available from 5 studies (N=127): the median of reported mean LOS was 5.0 days (range of means 3.7–20.6), with variable definitions of in-hospital time. QoL data were identified in 20 studies (N=555) using disparate instruments (e.g., SNOT-22 and others) and time points; numeric completeness and baseline-to-postoperative change with dispersion were infrequently provided, precluding quantitative pooling. Most series qualitatively suggested postoperative QoL improvement when measured. Conclusion: Endoscopic resection for ENB yields favorable long-term oncologic control, though outcomes likely vary by Kadish stage and Hyams grade, and may be influenced by extent of resection and adjuvant RT/CRT. Functional endpoints remain under-standardized—LOS is generally short, while QoL reporting is inconsistent—highlighting the need for prospective studies using validated instruments with complete summary statistics. Limitations: Predominantly retrospective, non-comparative designs; heterogeneous and often incomplete reporting of stage/grade, adjuvant therapy, and functional measures; substantial statistical heterogeneity for some oncologic endpoints. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany