Quality of life following endoscopic endonasal resection of anterior skull base cancers

Abstract

Object For several decades, the exclusive purpose in the management of anterior skull base malignancies has been to increase survival rates. Recently, given the improved prognosis achieved, more attention has been focused on quality of life (QOL) as well. Producing data on QOL in anterior skull base cancers is hampered by the rarity of the neoplasm and the lack of specific questionnaires. The purpose of this study was to assess health-related QOL in a large and homogeneous cohort of patients affected by anterior skull base cancers who had undergone endoscopic endonasal resection. Methods The authors conducted a retrospective review of patients treated for sinonasal and skull base cancers via an endoscopic endonasal approach at two Italian tertiary care referral centers. All patients were asked to complete the Anterior Skull Base Surgery Questionnaire to evaluate their QOL before and 1 month and 1 year after surgical treatment. To assess which parameters affect QOL, the study population was divided into subgroups according to age, sex, stage of disease, surgical approach, and adjuvant therapy. Results One hundred fifty-three patients were enrolled in this study according to the adopted inclusion criteria. Overall QOL started at a score of 4.68 for the preoperative period, sharply decreased as far as a score of 4.03 during the 1st postoperative month, and rose again to a score of 4.59 over the course of 1 year after treatment, with a significant difference among the 3 values (p < 0.05). The specific symptoms and physical status domains registered poorer results at the 1-year assessment (4.00 and 4.71, respectively) than at the preoperative assessment (both domains 4.86), with a statistically significant reduction in scores (p < 0.05). Worse outcomes were associated with several variables: age > 60 years (difference of 0.21 points between the preoperative and 1-year period, p < 0.05), expanded surgical approaches with transnasal craniectomy (decrease of 0.20 points between the preoperative and 1-year period, p < 0.05), and postoperative radiotherapy (score of 4.53 at the 1-year period vs 4.70 in patients without any adjuvant treatment, p < 0.05). No statistically significant differences were found when analyzing the study population according to sex (p > 0.1) and T classification of disease at presentation (p > 0.05). Conclusions Radical endoscopic endonasal resection led to either complete or at least partial recovery of patient QOL within the 1st postoperative year.

Septal flip flap per la ricostruzione del basicranio anteriore dopo resezione di tumori nasosinusali: risultati preliminari

“…Similar to what has been observed with other intranasal flaps 7 , we found very encouraging outcomes using the SFF not only in terms of skull base closure, but also in improvement of patients' quality of life. This was especially evident in comparison with extranasal grafts like the iliotibial tract placed overlay.…”

Multiportal Combined Transorbital Transnasal Endoscopic Approach for the Management of Selected Skull Base Lesions: Preliminary Experience

“…The philosophy of resecting to the "last piece" of dura mater invaded by the meningioma may not be the best choice for all patients. Philosophically speaking, the concept of minimal invasiveness is not simply dependent on the size of the entry wound but most importantly on the limited impact that the procedure has on the patient's quality of life (9). For this reason, any decision to attempt a complete resection of the lesion should be taken in accordance with the patient after careful, detailed, and honest discussion.…”

Sinonasal morbidity following endoscopic endonasal skull base surgery

“…Several questionnaires and tools have been introduced and used in clinical studies of endoscopic skull base surgery to assess QoL morbidity and sinonasal outcomes. These include Short Form-36 (SF-36), Anterior Skull Base Questionnaire (ASBQ), Rhinosinusitis Outcome Measure (RSOM)-31, Sinonasal Outcome Test (SNOT)-20, SNOT-22, and many others [6,7,24,26,[28][29][30][31][32][33]. However, due to several different questionnaires and no standardized definition for QoL, it is hard to compare different studies.…”