Abstract
Objective:
Resection of advanced malignancies of the cranio-orbito-facial complex often requires the combined efforts of head and neck, neurosurgical, oculoplastic, and microvascular reconstructive surgeons. Malignancies of this region represent a clinical entity that is uncommon, diverse in histopathology, complex in anatomical spread, and often associated with prior treatment failure. Prognosis remains poor despite aggressive surgery and adjuvant treatment. This study reviews our experience with surgery for advanced malignancies involving the cranio-orbito-facial complex, with specific regard to morbidity and mortality of surgery, disease recurrence, survival, and prognostic factors.
Design:
Retrospective single institution case series were reviewed at a tertiary care university hospital.
Methods:
All cases between 1999 and 2010 of patients who underwent a combined multiple team procedure-including a head and neck surgeon, a neurosurgeon, and an oculoplastic surgeon—for advanced malignancies of the cranio-orbito-facial complex were included. Patient demographics, tumor characteristics, operative reports, and clinical follow-up were recorded. Main outcome measures were postoperative complications, overall survival, and disease-free survival.
Results:
Forty-six patients with advanced cranio-orbito-facial malignancies were included. Seventeen patients presented having failed prior treatment. Orbital exenteration/clearance was done in 22 patients, and 24 patients underwent conservative orbital surgery. There were 22 wound-related complications, 9 of which were major requiring a second operative procedure. One patient died in the immediate postoperative period. Seven patients had postoperative medical complications. Mean follow-up time was 25.1 months, with series 5-year overall survival of 69% and series 5-year disease-free survival of 20%. Local-regional recurrence occurred in 17 patients, and 6 cases experienced distant metastatic recurrence. Mean disease-free survival was 9.8 months for the 12 patients with cutaneous malignancies and 45.3 months for the 34 patients with malignancies of noncutaneous origin (
P
< 0.01). Neither previous treatment nor orbital exenteration/clearance seemed to be associated with poorer survival.
Conclusions:
Advanced malignancies of the cranio-orbital-facial complex are best managed using a combined surgical approach with head and neck surgery, neurosurgery, and oculoplastic surgery. Surgical outcome, complications, and prognostic factors are reviewed in this large series of patients.