Prospective Evaluation of Health-Related Quality of Life in Patients Undergoing Anterolateral Craniofacial Resection with Orbital Exenteration
09 February 2019
28 May 2019
24 July 2019 (online)
Objective This study was aimed to evaluate health-related quality of life in patients undergoing anterolateral craniofacial resection (AL-CFR) with orbital exenteration (OE) for malignant skull base tumors and to investigate the effects of early psychiatric intervention.
Design Present study is a prospective, observational study.
Setting The study took place at the hospital department.
Participants Twenty-six consecutive patients were selected who underwent AL-CFR with OE at our hospital between 2005 and 2015.
Main Outcome Measures Health-related quality of life was assessed preoperatively and 3, 6, 12, and 24 months after surgery using the Hospital Anxiety and Depression Scale (HADS) and medical outcomes study 8-items Short Form health survey (SF-8). In all cases, psychiatric intervention was organized by the consultation liaison psychiatry team preoperatively and postoperatively.
Results Ten (38.0%) of the 26 patients died and 16 (62.0%) were alive and disease-free at the end of the study. The 3-year overall and disease-free survival rates were 64.9% and 53.3%, respectively. Twenty-one patients (80.8%) developed psychiatric complications after surgery and needed treatment with psychotropic medication. Before surgery, 28% of patients had HADS scores ≥8 for anxiety and 20% had scores ≥8 for depression. Seven of the eight items in the SF-8 were significantly lower than those for the general Japanese population. However, scores for all the SF-8 items gradually improved during postoperative follow-up, reaching approximately 50 points, which is the national standard value, at 2 years after surgery.
Conclusions Craniofacial resection with OE was feasible and well tolerated in patients with malignant skull base tumors who received early psychiatric intervention to decrease the considerable psychological impact of this procedure.
Keywordsanterolateral craniofacial resection - orbital exenteration - quality of life - skull base malignant tumor - early psychiatric intervention - hospital anxiety and depression scale - medical outcomes study 8-items short form health survey
* These authors contributed equally to this work.
- 1 Ketcham AS, Wilkins RH, Vanburen JM, Smith RR. A combined intracranial facial approach to the paranasal sinuses. Am J Surg 1963; 106: 698-703
- 2 Ganly I, Patel SG, Singh B. , et al. Craniofacial resection for malignant paranasal sinus tumors: report of an International Collaborative Study. Head Neck 2005; 27 (07) 575-584
- 3 Bilsky MH, Bentz B, Vitaz T, Shah J, Kraus D. Craniofacial resection for cranial base malignancies involving the infratemporal fossa. Neurosurgery 2005; 57 (4, Suppl.): 339-347 , discussion 339–347
- 4 Cantu G, Solero CL, Riccio S. , et al. Surgery for malignant maxillary tumors involving the middle cranial fossa. Skull Base 2010; 20 (02) 55-60
- 5 Saito K, Fukuta K, Takahashi M, Tachibana E, Yoshida J. Management of the cavernous sinus in en bloc resections of malignant skull base tumors. Head Neck 1999; 21 (08) 734-742
- 6 Nishio N, Fujii M, Hayashi Y. , et al. Preoperative surgical simulation and validation of the line of resection in anterolateral craniofacial resection of advanced sinonasal sinus carcinoma. Head Neck 2017; 39 (03) 512-519
- 7 Nishio N, Fujimoto Y, Fujii M. , et al. Craniofacial resection for T4 maxillary sinus carcinoma: managing cases with involvement of the skull base. Otolaryngol Head Neck Surg 2015; 153 (02) 231-238
- 8 Heo YH, Yagi S, Toriyama K. , et al. Relationship between BMI and postoperative complications with free flap in anterolateral craniofacial reconstruction. Plast Reconstr Surg Glob Open 2016; 4 (03) e636
- 9 Iwami K, Fujii M, Kishida Y. , et al. Role of transcranial sphenoidotomy in skull base surgery: classification of surgical techniques based on the surgical anatomy of the sphenoid sinus. J Neurosurg 2018; 1: 1-10
- 10 Howard DJ, Lund VJ, Wei WI. Craniofacial resection for tumors of the nasal cavity and paranasal sinuses: a 25-year experience. Head Neck 2006; 28 (10) 867-873
- 11 Neel GS, Nagel TH, Hoxworth JM, Lal D. Management of orbital involvement in sinonasal and ventral skull base malignancies. Otolaryngol Clin North Am 2017; 50 (02) 347-364
- 12 Nazar G, Rodrigo JP, Llorente JL, Baragaño L, Suárez C. Prognostic factors of maxillary sinus malignancies. Am J Rhinol 2004; 18 (04) 233-238
- 13 Patel SG, Singh B, Polluri A. , et al. Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Cancer 2003; 98 (06) 1179-1187
- 14 Bentz BG, Bilsky MH, Shah JP, Kraus D. Anterior skull base surgery for malignant tumors: a multivariate analysis of 27 years of experience. Head Neck 2003; 25 (07) 515-520
- 15 Ma C, Li J, Shen Y, Wu Y, Shi R, Sun J. Is there a role for craniofacial surgery in the treatment of extensive or recurrent head and neck tumors involving the cranial base?. J Oral Maxillofac Surg 2017; 75 (09) 2006-2019
- 16 Liu L, Liu D, Guo Q, Shen B. Quality of life in advanced maxillary sinus cancer after radical versus conservative maxillectomy. J Craniofac Surg 2013; 24 (04) 1368-1372
- 17 Rasmussen MLR, Ekholm O, Prause JU, Toft PB. Quality of life of eye amputated patients. Acta Ophthalmol 2012; 90 (05) 435-440
- 18 Prieto JM, Atala J, Blanch J. , et al. Role of depression as a predictor of mortality among cancer patients after stem-cell transplantation. J Clin Oncol 2005; 23 (25) 6063-6071
- 19 Hamilton JB, Deal AM, Moore AD, Best NC, Galbraith KV, Muss H. Psychosocial predictors of depression among older African American patients with cancer. Oncol Nurs Forum 2013; 40 (04) 394-402
- 20 Jansen F, Verdonck-de Leeuw IM, Cuijpers P. , et al. Depressive symptoms in relation to overall survival in people with head and neck cancer: a longitudinal cohort study. Psychooncology 2018; 27 (09) 2245-2256
- 21 Adachi Y, Kimura H, Sato N. , et al. Preoperative level of depression is a predictor of postoperative levels of depression in patients with head and neck cancer. Jpn J Clin Oncol 2014; 44 (04) 311-317
- 22 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Publishing; 2013
- 23 Kugaya A, Akechi T, Okuyama T, Okamura H, Uchitomi Y. Screening for psychological distress in Japanese cancer patients. Jpn J Clin Oncol 1998; 28 (05) 333-338
- 24 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67 (06) 361-370
- 25 Ware JE, Kosinski M, Dewey JE, Gandek B. How to Score and Interpret Single-Item Health Status Measures: A Manual for Users of the SF-8 Health Survey. Quality Metric Inc., Lincoln, RI; 2001
- 26 Fukuhara S, Suzukamo Y. Manual of the SF-8 Japanese version. Kyoto: Institute for Health Outcomes and Process Evaluation Research; 2004. (in Japanese)
- 27 Sugimoto H, Kawashima H, Ohno E. , et al. The prognostic factors and trajectory of HRQOL in patients with pancreatic cancer who received psychiatric intervention. J Gastroenterol Hepatol 2016; 31 (03) 685-690
- 28 Galway K, Black A, Cantwell M, Cardwell CR, Mills M, Donnelly M. Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database Syst Rev 2012; 11: CD007064
- 29 Abergel A, Fliss DM, Margalit N, Gil Z. A prospective evaluation of short-term health-related quality of life in patients undergoing anterior skull base surgery. Skull Base 2010; 20 (01) 27-33
- 30 Kam D, Salib A, Gorgy G. , et al. Incidence of suicide in patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg 2015; 141 (12) 1075-1081
- 31 de Almeida JR, Witterick IJ, Gullane PJ. , et al. Quality of life instruments for skull base pathology: systematic review and methodologic appraisal. Head Neck 2013; 35 (09) 1221-1231
- 32 Kaji M, Fujiwara Y, Shiba M. , et al. Prevalence of overlaps between GERD, FD and IBS and impact on health-related quality of life. J Gastroenterol Hepatol 2010; 25 (06) 1151-1156
- 33 Leonhardt FD, Quon H, Abrahão M, O'Malley Jr BW, Weinstein GS. Transoral robotic surgery for oropharyngeal carcinoma and its impact on patient-reported quality of life and function. Head Neck 2012; 34 (02) 146-154
- 34 Vartanian JG, Toledo RN, Bueno T, Kowalski LP. Orbital exenteration for sinonasal malignancies: indications, rehabilitation and oncologic outcomes. Curr Opin Otolaryngol Head Neck Surg 2018; 26 (02) 122-126
- 35 Muscatello L, Fortunato S, Seccia V, Marchetti M, Lenzi R. The implications of orbital invasion in sinonasal tract malignancies. Orbit 2016; 35 (05) 278-284
- 36 Reyes C, Mason E, Solares CA, Bush C, Carrau R. To preserve or not to preserve the orbit in paranasal sinus neoplasms: a meta-analysis. J Neurol Surg B Skull Base 2015; 76 (02) 122-128
- 37 Safi A-F, Behn L, Rothamel D. , et al. Therapy of sinonasal malignancies invading the orbit-orbital exenteration versus preservation of the orbit plus radiotherapy. J Craniomaxillofac Surg 2017; 45 (02) 258-261