Short-term survival in extensive craniofacial resections

Abstract

Objectives: Craniofacial resection (CFR) procedures for craniofacial tumors with cranial extension are often extensive. Although CFRs may yield good oncological results, there are concerns about high perioperative morbidity and mortality. This study aimed to determine risk factors for perioperative mortality after open CFR in terms of deaths occurring during index hospitalizations.

Methods: We conducted a retrospective analysis of CFRs conducted at a tertiary oncology hospital from May 2009 through December 2018.

Results: Our analysis included data from the medical records of 102 patients, the majority of whom were male (n=74, 72.5%). The mean age was 61 years (±18.3 years). Skin malignancies (n=64, 63.4%) accounted for nearly two-thirds of the treated tumors, and most of these were squamous cell carcinoma. Postoperative medical complications occurred in 33 patients (33%), and surgical complications occurred in 48 (47%). Multivariate analysis revealed the only independent risk factors for perioperative deaths to be the presence of intracranial tumor extension on preoperative imaging (hazard ratio [HR]=4.56; 95% confidence interval [CI]: 1.74-11.97; p=0.002) and the unexpected emergence of postoperative neurological dysfunction (HR=10.9; 95% CI: 2.21-54.3; p=0.003).

Conclusions: In our study, factors related to tumor extension were associated with a higher risk of perioperative death.

Figure 1. An extensive adenoid cystic carcinoma with skull base invasion submitted to craniofacial resection and microsurgical free flap reconstruction. No major complications. Images A, B, and C show preoperative scans showing a large tumor involving the maxilla and middle fossa; D, the surgical defect after en bloc tumor resection; E, the surgical specimen; and F, the immediate result after reconstruction.

Figure 2. Kaplan-Meier curves demonstrating poor cumulative survival among patients with intracranial tumor extension (88.0 vs. 52.6%; p<0.001; log-rank test).