Combined transfacial and neurosurgical approach to malignant tumours of the ethmoid sinus

Abstract

In order to understand the risks and benefits of a combined transfacial and neurosurgical procedure for neoplasms of the ethmoid sinus, we reviewed all patients who underwent this surgical approach in our department between 1986 and 1994.The study included 41 patients. Pathological diagnoses included adenocarcinoma (31 patients), squamous cell carcinoma (three patients), aesthesioneuroblastoma (three patients), other (four patients). The overall morbidity rate was 39 per cent, and the post-operative mortality rate was 2.5 per cent. Complications were statistically more likely in patients with bone skull base reconstruction. The main carcinologic failures were local recurrences (24 per cent) and metastases (22 per cent). The one-year, three-year and five-year Kaplan Meir survival rates were respectively 84 per cent, 53 per cent and 36 per cent. In conclusion, the mortality and morbidity were acceptable, especially when no bone skull base reconstruction was performed. Better local control justifies a combined procedure with post-operative radiotherapy when tumours involve or reach the skull base.

Sinonasal Adenocarcinoma—Experience of an Oncology Center

“…In ethmoid adenocarcinoma, despite the improvements in surgical and anesthetic techniques, survival data with CFR approach remain disappointing [1]. Our survival rates results confirm this suspicion with no great difference to other studies that currently perform CFR, whose overall survival rates at 5 and 10 years goes from 36% to 57% and 28% to 53%, respectively [7,[11][12][13][14][15]. Our good survival results also suggest that for well selected cases and with the appropriate use of adjuvant therapy, endoscopic resection of sinonasal cancer results in acceptable oncologic outcomes.…”

Ethmoid sinus cancer: Results of treatment with surgery and combined therapy

“…As was the case for earlier reports (9,10,12,13,18), the advanced stages of ethmoid sinus cancer were associated with a higher risk of regional and distant metastasis than the early stages. In addition, local treatment failure would appear to be more common than regional and distant treatment failures.…”

“…Previous reports have revealed 3-year overall and disease-free survival rates of 52Á/71% and 30Á/67%, respectively (5,8,9,18). In our study, 3-year overall and disease-free survival rates were 49.4% and 26.3%, respectively.…”

“…In addition, local treatment failure would appear to be more common than regional and distant treatment failures. Neck lymph node recurrence (0 Á/8%) has been reported in the literature, albeit infrequently (5,6,8,9), and 5/15 T3 Á/T4 patients (33%) in our study developed some sort of neck recurrence. Furthermore, we found that three out of five patients with neck recurrence also had distant metastasis.…”

“…The advantages of craniofacial resection, which combines cranial and transfacial approaches, have been emphasized by many surgeons dealing with cancers of the ethmoid region, especially for cases involving cribriform plate invasion (2, 5, 9, 12, 20Á/22). Although there appears to be some acceptable variation in technique with regard to incision and reconstruction for such surgery, the reported overall morbidity of craniofacial resection ranges from 28% to 63% and the postoperative mortality is 0Á/2.7% (9,20). Fortunately, no perioperative mortality occurred in our study and all complications were resolved smoothly.…”