Is there a role for craniofacial surgery in the treatment of extensive or recurrent head and neck tumors involving cranial bases?

Publication date: Available online 8 February 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Chunyue Ma, Jun Li, Yi Shen, Yiqun Wu, Runjie Shi, Jian Sun
PurposeExtensive or recurrent head and neck tumors involving the cranial base are extremely difficult to treat on a surgical perspective. The purposes of this study are to estimate and identify factors associated with overall survival after traditional craniofacial resection of these cases, and to discuss the specific indications and treatment outcomes.MethodsFrom January 2005 to December 2014, a retrospective cohort study was performed with the analysis of the patients diagnosed with extensive or recurrent head and neck tumors extending to the skull base. The clinical records were reviewed for predictor variables regarding demographics, prior treatment status, pathologic characteristics, tumor sites and sizes, skull base bone or brain parenchyma invasions, reconstructive approaches, surgical margins and adjuvant therapies. The outcome variable was overall survival. Overall survival was estimated using Kaplan Meier methods and risk factors were identified using Cox modeling.ResultsThe cohort was composed of 119 subjects with a mean age of 44.53 years old and 67 (56.30%) were male. Through-and-through resection of the skull base bones (dural exposure) was performed in one hundred patients (84.03%). The overall complication rate for the entire group was 42.86% and the perioperative mortality was 2.52% (n=3). The mean follow-up period reached 43.88 months. Of these patients (n=116), 39 experienced local recurrences. After multivariate analysis, surgical margin (P=0.001), pathological classification (P=0.016), extent of skull base involvement (P=0.001) were found to be independent factors affecting overall survival.ConclusionCraniofacial surgery for extensive or recurrent skull base lesions is feasible on well-selected patients.



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