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.
Highlights
Craniofacial resections (CFRs) are complex procedures that have evolved, in terms of safety and expanded indications, since their first description [1]
The case series was composed of 102 patients who underwent CFR
This report presents data and analytical findings derived from a large cohort of patients from a single oncologic institution. These patients underwent extensive open CFRs mainly for malignant lesions, and this study focused on factors associated with perioperative death rather than longterm survival
Summary
Craniofacial resections (CFRs) are complex procedures that have evolved, in terms of safety and expanded indications, since their first description [1]. Surgical technology, and reconstruction techniques have redefined the applications and limits of CFRs, with wider resections coinciding with encouraging outcomes [2,3]. Even though CFR is the treatment of choice for a wide variety of benign and malignant lesions involving the skull base, these surgeries are relatively uncommon, except in high-volume, specialized centers. This infrequency—in combination with differences in tumor histology and varying definitions of CFRs—leads to heterogeneous reporting in the literature [3,7,8].
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