Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia.
Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia; Department of Plastic Surgery, St. Vincent's Hospital, Sydney, Australia.
World Neurosurg. 2021 Jun;150:e102-e107. doi: 10.1016/j.wneu.2021.02.092. Epub 2021 Feb 26.
The role of surgery is not well defined in locally advanced sinonasal cancers with intracranial involvement after all medical options have been exhausted. We hypothesize that patients whose tumors are deemed unresectable and referred to palliative care may benefit from radical salvage surgery.
We performed a single-center retrospective review of patients with malignant, locally advanced (stage T4b) sinonasal cancers with intracranial involvement from 2000 to 2020, inclusive. Data were collected on the patient demographics, details of chemotherapy, radiation, histology, perioperative complications, surgical approaches, and survival. We compared the survival outcomes of patients with different duration of disease before presentation.
We identified 17 patients who had undergone salvage surgical resection of treatment-recalcitrant, locally advanced sinonasal tumors. Almost all patients had undergone prior surgery, radiotherapy, and chemotherapy. Perioperative complications occurred in 6 of 17 patients with 1 death. Patients with clinically less aggressive disease had significantly longer progression-free and overall survival compared with the more aggressive group.
Salvage surgery for locally advanced sinonasal cancers with intracranial invasion that is recalcitrant to all other therapies should be considered for patients who otherwise have no other treatment options.
在所有医疗选择都已用尽的情况下，对于局部晚期伴颅内侵犯的鼻窦癌，手术的作用尚未明确。我们假设，对于那些被认为无法切除并转至姑息治疗的肿瘤患者，根治性挽救性手术可能会带来获益。
我们对 2000 年至 2020 年间收治的所有局部晚期（T4b 期）伴颅内侵犯的恶性鼻窦癌患者进行了单中心回顾性研究。收集了患者的人口统计学、化疗、放疗、组织学、围手术期并发症、手术方法和生存数据。我们比较了不同疾病持续时间的患者的生存结果。
我们共纳入了 17 例接受治疗抵抗性局部晚期鼻窦肿瘤挽救性手术切除的患者。几乎所有患者都曾接受过手术、放疗和化疗。17 例患者中有 6 例发生围手术期并发症，其中 1 例死亡。与侵袭性更强的患者相比，临床侵袭性较弱的患者无进展生存期和总生存期明显更长。
对于所有其他治疗方法均无效的局部晚期伴颅内侵犯鼻窦癌患者，若别无他法，应考虑行挽救性手术。
