广泛颅面切除术的短期存活率。
Short-term survival in extensive craniofacial resections.
机构信息
Departamento de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, BR.
Departamento de Neurocirurgia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, BR.
出版信息
Clinics (Sao Paulo). 2021 May 21;76:e2836. doi: 10.6061/clinics/2021/e2836. eCollection 2021.
OBJECTIVES
Craniofacial resection (CFR) procedures for craniofacial tumors with cranial extension are often extensive. Although CFRs may yield good oncological results, there are concerns about high perioperative morbidity and mortality. This study aimed to determine risk factors for perioperative mortality after open CFR in terms of deaths occurring during index hospitalizations.
METHODS
We conducted a retrospective analysis of CFRs conducted at a tertiary oncology hospital from May 2009 through December 2018.
RESULTS
Our analysis included data from the medical records of 102 patients, the majority of whom were male (n=74, 72.5%). The mean age was 61 years (±18.3 years). Skin malignancies (n=64, 63.4%) accounted for nearly two-thirds of the treated tumors, and most of these were squamous cell carcinoma. Postoperative medical complications occurred in 33 patients (33%), and surgical complications occurred in 48 (47%). Multivariate analysis revealed the only independent risk factors for perioperative deaths to be the presence of intracranial tumor extension on preoperative imaging (hazard ratio [HR]=4.56; 95% confidence interval [CI]: 1.74-11.97; p=0.002) and the unexpected emergence of postoperative neurological dysfunction (HR=10.9; 95% CI: 2.21-54.3; p=0.003).
CONCLUSIONS
In our study, factors related to tumor extension were associated with a higher risk of perioperative death.
目的
颅面切除术（CFR）用于颅外颅面肿瘤的手术通常广泛。虽然 CFR 可能会带来良好的肿瘤学结果，但人们对围手术期高发病率和死亡率存在担忧。本研究旨在确定开放 CFR 后围手术期死亡率的危险因素，即索引住院期间的死亡。
方法
我们对 2009 年 5 月至 2018 年 12 月在一家三级肿瘤医院进行的 CFR 进行了回顾性分析。
结果
我们的分析包括 102 名患者的病历数据，其中大多数为男性（n=74，72.5%）。平均年龄为 61 岁（±18.3 岁）。皮肤恶性肿瘤（n=64，63.4%）占治疗肿瘤的近三分之二，其中大多数为鳞状细胞癌。33 名患者（33%）发生术后医疗并发症，48 名患者（47%）发生手术并发症。多变量分析显示，术前影像学检查存在颅内肿瘤延伸（危险比[HR]=4.56；95%置信区间[CI]：1.74-11.97；p=0.002）和术后意外出现神经功能障碍（HR=10.9；95% CI：2.21-54.3；p=0.003）是围手术期死亡的唯一独立危险因素。
结论
在我们的研究中，与肿瘤延伸相关的因素与围手术期死亡风险增加相关。
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