Craniofacial resection of malignant tumors of the anterior skull base: a case series and a systematic review
Craniofacial resection (CFR) is still considered as the gold standard for managing sinonasal malignancies of the anterior skull base (ASB), while endoscopic approaches are gaining credibility. The goal of this study was to evaluate outcomes of patients who underwent CFR at our institution and to compare our results to international literature.
Retrospective analysis of all patients undergoing CFR between 1995 and 2017, and systematic literature review according to the PRISMA statement.
Forty-one patients with sinonasal malignancy (81% with stage T4) of the ASB were included. There was no operative mortality. Complications were observed in 9 cases. We obtained 100% follow-up with mean observation of 100 months. Disease-specific survival rates were 90%, 74%, and 62% and recurrence-free survival was 85% at two, 72% at five, and 10 years follow-up, respectively. CFR as primary treatment, en bloc resection, and resection with negative margins correlated to better survival. Recursive partition analysis identified the latter as the most important prognostic factor, regardless of surgical technique. The relative risk of non-radicality was significantly higher after piecemeal resection compared to en bloc resection. Compared to 15 original articles, totaling 2603 patients, eligible for review, the present study has the longest follow-up time, the second highest 5-year OS, and the third highest 5-year DSS, despite having a higher proportion of patients with high-stage disease.
CFR in true en bloc fashion can still be considered as the treatment of choice in cases of advanced-stage sinonasal malignancies invading the ASB.
KeywordsSkull base tumors Craniofacial resection Multidisciplinary approach Multimodal treatment Survival
Abbreviations and acronyms
Anterior skull base
Alive with disease
Died of disease
Extended endonasal approach
Gross total resections
No evidence of disease
Oslo University Hospital
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Recursive partitioning analysis
Squamous cell carcinoma
Sinonasal undifferentiated carcinoma
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the data protection official at OUH (ePhorte 2015-5042). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study does not contain any studies with animals performed by any of the authors.
For this type of study, formal consent is not required.
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