Outcomes following temporal bone resection

Abstract

Objectives/Hypothesis To evaluate survival outcomes in patients undergoing temporal bone resection. Study Design Retrospective review. Methods From 2002 to 2009 a total of 65 patients underwent temporal bone resection for epithelial (n = 47) and salivary (n = 18) skull base malignancies. Tumor characteristics, defect reconstruction, and postoperative course were assessed. Outcomes measured included disease-free survival and cancer recurrence. Results The majority of patients presented with recurrent (65%), advanced stage (94%), cutaneous (72%), and squamous cell carcinoma (57%). Thirty-nine patients had perineural invasion (60%) and required facial nerve resection; 16 (25%) had intracranial extension. Local (n = 6), regional (n = 2), or free flap (n = 46) reconstruction was required in 80% of patients. Free flap donor sites included the anterolateral thigh (31%), radial forearm free flap (19%), rectus (35%), and latissimus (4%). The average hospital stay was 4.9 days (range, 1–28 days). The overall complication rate was 15% and included stroke (n = 4), cerebrospinal fluid leak (n = 2), hematoma formation (n = 1), infection (n = 1), flap loss (n = 1), and postoperative myocardial infarction (n = 1). A total of 22 patients (34%) developed cancer recurrence during the follow-up period (median, 10 months), 17 (77%) of whom presented with recurrent disease at the time of temporal bone resection. Two-year disease-free survival was 68%, and 5-year disease-free survival was 50%. Conclusions Aggressive surgical resection and reconstruction is recommended for primary and recurrent skull base malignancies with acceptable morbidity and improved disease-free survival.

Predictors of Survival and Recurrence after Temporal Bone Resection for Cancer

“…The extant literature consists of numerous case series that have reported a wide range of survival data, reflecting differences in the underlying characteristics of cohorts drawn from various institutions. 1,6,[8][9][10][12][13][14][15]18,19,22,24,[30][31][32][33][34][35][36][37][38][39][40][41] Historical survival data can be most readily generalized to clinical practice if factors predictive of outcome can be identified. Several larger series have reported preliminary descriptions of factors influencing survival, based on univariate comparisons.…”

“…Several larger series have reported preliminary descriptions of factors influencing survival, based on univariate comparisons. 2,6,7,16,20,21,24 In this study, we use multivariable analyses to identify factors independently associated with survival and recurrence in 72 patients undergoing temporal bone resection over 16 years at our 2 affiliated institutions. In all, 80% of cases were epithelial cancers, and 83% of patients underwent lateral temporal bone resection as the primary temporal bone procedure.…”

“…Most cohorts have been limited to squamous cell histology, and comprehensive outcomes analyses have been limited. 2,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Further complicating analysis, there is no recognized American Joint Committee on Cancer (AJCC) or Union Internationale Contre le Cancer (UICC) staging system for tumors of the external auditory canal/temporal bone, with multiple systems having been proposed. 3,16,25,26 To date, the most widely used system is the University of Pittsburgh staging system, first described in 1990 by Arriaga and colleagues 25 and modified in 2000 by Moody et al 3 Other than Pittsburgh stage and surgical margin status, no other factors have been consistently demonstrated to be associated with outcome, and multivariable analyses of factors affecting outcome have not been reported.…”

Perineural invasion and spread in head and neck cancer

“…Stroke (four patients) and cerebrospinal fluid leak (two patients) were the most common complications. The 2-and 5-year diseasefree intervals were 68 and 50%, respectively, highlighting the curability of perineural disease in selected patients [56]. In the event that disease is unresectable or complete resection of the nerve is considered too morbid, treatment of the nerve should be undertaken with radiotherapy either alone or in combination with systemic therapy.…”

Temporal bone carcinoma: Classical prognostic variables revisited and modern clinico-pathological evidence

“…11,13,16,17 The pathological grading of the tumor was reported as a factor related to worse prognosis only in a limited number of series. 10,18 In part, facial nerve involvement continues to be controversial with a significant negative prognostic role found by most 11,12,15,16,[19][20][21][22] but not all groups. 23 Dura mater infiltration evidence (both radiological and/or pathological) was reported in most of the series 10,11,21,22 as the strongest negative prognostic factor affecting survival.…”