Craniofacial Resection for Sinonasal Malignant Tumors: Statistical Analysis of Surgical Outcome over 17 Years at a Single Institution

Abstract

We present a retrospective analysis of surgical outcome of sinonasal malignant tumors. Overall survival (OS), disease-specific survival (DSS), local control (LC), and disease-free survival (DFS) were calculated in 32 patients. Prognostic factors for survival and functional outcomes were investigated. The median follow-up period was 70 months. At 5 years, OS, DSS, LC, and DFS rates were 0.722, 0.745, 0.851, and 0.707, respectively. Prognostic factors for poor OS were involvement of the frontal sinus (p = 0.023), T classification (T4, p = 0.025), surgical complications (p = 0.029), chemotherapy (p = 0.035) postsurgical infection (p = 0.043), involvement of the orbit (p = 0.048), histology (squamous cell carcinoma, p = 0.049), and radiotherapy (p = 0.043). Prognostic factors for poor DSS were radiotherapy (p = 0.030), chemotherapy (p = 0.036), positive surgical margin (p = 0.034), and T classification (T4, p = 0.050). LC was adversely influenced by surgical procedure (combined frontotemporal resection, p = 0.035) and positive surgical margin (p = 0.049). DFS was adversely influenced by positive surgical margin (p = 0.001). Prognostic factors for poor functional outcome were postsurgical infection (p = 0.039), postsurgical complications (p = 0.040), tumor location (maxillary sinus, p = 0.042, orbit, p = 0.0002), number of sinuses involved (number of sinuses involved was inversely proportional to functional outcome, p = 0.027), T classification (T4 p = 0.007), pathology (squamous cell carcinoma, p = 0.023), and chemotherapy (p = 0.048). Craniofacial resection was an effective surgical option.

Endoscopic nasal versus open approach for the management of sinonasal adenocarcinoma: A pooled‐analysis of 1826 patients

“…All series were retrospective. Most series presented outcome data from heterogeneous histologies, at differing stages, of patients who received a variety of treatment strategies over a relatively long timeframe. The largest series of ethmoid adenocarcinomas was published by the French GETTEC group .…”

Treatment outcomes of concurrent chemoradiotherapy for locally advanced sinonasal squamous cell carcinoma: A single-institution study

“…Curative radical surgery for stage III/IV sinonasal SCC should include resection of the orbit, palate, skin, brain, and/or cranial nerve as appropriate. Sacrifice of these structures can cause esthetic and functional problems, both of which can directly impact patient quality-of-life [2,4,5,13]. CCRT is an accepted treatment for locally advanced SCC of the head and neck, with the aim of preserving the primary tumor site and improving patient survival [6][7][8]14,15].…”

“…Tumors invading the orbital contents and/or dura require orbit exenteration or enucleation, leading to permanent vision loss; orbit defects during restoration of the myocutaneous free flap [5]; and/or craniofacial resection. Craniofacial resection can cause frequent surgical complications, including local infection, frontal lobe contusion, meningitis with CSF leakage, and cranial nerve disturbances [13]. Total maxillectomy for resectable lesions also causes esthetic concerns, difficulty of speech and swallowing, abnormal positioning of the eyeball, and/or diplopia, even when the maxillectomy defect is reconstructed from the free flap [5].…”

Microscopic tumor invasion of contralateral mucosa in cancer involving unilateral septum

“…[4][5][6] Moreover, current research into the utility of neoadjuvant chemotherapy to transform a surgically unresectable sinonasal tumor into one more amendable to a complete resection are being studied. 8,9 Therefore, obtaining information regarding margin status of tumor is critical as it is one of the most significant prognostic factors for recurrence. 8 The importance of achieving negative margins in terms of decreasing recurrence and improving overall survival has been described in a number of studies.…”