Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study.
BACKGROUND
Advances in imaging, surgical technique, and perioperative care have made craniofacial resection (CFR) an effective and safe option for treating malignant tumors involving the skull base. The procedure does, however, have complications. Because of the relative rarity of these tumors, most existing data on postoperative complications come from individual reports of relatively small series of patients. This international collaborative report examines a large cohort of patients accumulated from multiple institutions with the aim of identifying patient-related and tumor-related predictors of postoperative morbidity and mortality and set a benchmark for future studies.


METHODS
One thousand one hundred ninety-three patients from 17 institutions were analyzed for postoperative mortality and complications. Postoperative complications were classified into systemic, wound, central nervous system (CNS), and orbit. Statistical analyses were carried out in relation to patient characteristics, extent of disease, prior radiation treatment, and type of reconstruction to determine factors that predicted mortality or complications.


RESULTS
Postoperative mortality occurred in 56 patients (4.7%). The presence of medical comorbidity was the only independent predictor of mortality. Postoperative complications occurred in 433 patients (36.3%). Wound complications occurred in 237 (19.8%), CNS-related complications in 193 (16.2%), orbital complications in 20 (1.7%), and systemic complications in 57 (4.8%) patients. Medical comorbidity, prior radiation therapy, and the extent of intracranial tumour involvement were independent predictors of postoperative complications.


CONCLUSIONS
CFR is a safe surgical treatment for malignant tumors of the skull base, with an overall mortality of 4.7% and complication rate of 36.3%. The impact of medical comorbidity and intracranial tumor extent should be carefully considered when planning therapy for patients whose tumors are amenable to CFR.
Ganly
Ian
I
Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
Patel
Snehal G
SG
Singh
Bhuvanesh
B
Kraus
Dennis H
DH
Bridger
Patrick G
PG
Cantu
Giulo
G
Cheesman
Anthony
A
De Sa
Geraldo
G
Donald
Paul
P
Fliss
Dan
D
Gullane
Patrick
P
Janecka
Ivo
I
Kamata
Shin-etsu
SE
Kowalski
Luiz P
LP
Levine
Paul
P
Medina
Luiz R
LR
Pradhan
Sultan
S
Schramm
Victor
V
Snyderman
Carl
C
Wei
William I
WI
Shah
Jatin P
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D019292:Skull Base Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*