title: Advantage of Extended Craniofacial Resection for Advanced Malignant Tumors of the Nasal Cavity and Paranasal Sinuses: Long-Term Outcome and Surgical Management.
abstract: OBJECTIVE
  Craniofacial resection (CFR) for advanced sinonasal malignant tumors (SNMTs) is mandatory for radical resection. Surgeons must be aware of perioperative complications and long-term outcome because this procedure is extremely invasive, especially when the tumor involves the anterior skull base.
  
  
  METHODS
  Thirty-eight consecutive surgical patients with advanced SNMT of T4 stage or Kadish stage C (31 men and 7 women; mean age, 55 years; range: 19-76 years) treated with CFR in the past 28 years were followed up for 59.4 months. In cases of unilateral orbital extension, en-bloc resection was achieved using several neurosurgical techniques (extended CFR) from 2005 onwards. Herein, we evaluated the safety and effectiveness of surgery by comparing survival data between 2 time periods (first stage: 1984-2004, second stage: 2005-2012).
  
  
  RESULTS
  Squamous cell carcinoma was the most common histological type observed (65.8%), followed by esthesioneuroblastoma (15.8%). Using a combination of adjuvant radiation therapy, the 5-year overall survival and the 5-year disease-specific survival rates were 55.5% and 59.4%, respectively. Sarcomatous histology was a poor prognostic factor. The 5-year disease-specific survival rate was 48.9% in the first stage and improved to 82.1% in the second stage (P = 0.057); this was related to improvements in local control rate.
  
  
  CONCLUSIONS
  CFR and postoperative radiotherapy are safe and effective for treating advanced SNMTs. Extended CFR, including radical orbital exenteration, may contribute to good long-term outcomes. A diverse surgical team may help perform radical resection and reconstruction in patients with advanced tumors.
authors.affiliation: Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan. Electronic address: kiyo@med.kurume-u.ac.jp.
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Sakata
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Akiteru
authors.initials: A
authors.lastname: Maeda
authors.affiliation: Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Rikimaru
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Takeharu
authors.initials: T
authors.lastname: Ono
authors.affiliation: Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Koga
authors.affiliation: Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takeshige
authors.affiliation: Ichinomiya Neurosurgery Hospital, Oita, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Tokutomi
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Umeno
authors.affiliation: Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kiyokawa
authors.affiliation: Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
authors.forename: Motohiro
authors.initials: M
authors.lastname: Morioka
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D018304:Esthesioneuroblastoma, Olfactory / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anterior skull base; Craniofacial resection; En-bloc resection; Long-term outcome; Orbital exenteration; Paranasal sinus; Sinonasal malignant tumors