Timing of Neck Dissection for Patients with Sinonasal Malignancy Undergoing Anterior Cranial Base Resection

Background: Given the rarity and heterogeneity of sinonasal malignancies (SNM), the specifics of SNM treatment vary across institutions and providers. The timing of neck dissection in patients who have SNM has not been previously studied. Challenges in performing a neck dissection on the same day include increased length of surgery time and coordination of multiple surgical teams. However, a delayed neck dissection may lead to delayed radiation treatment and require multiple recoveries from surgery. This is the first study to examine the timing of neck dissection and its impact on patient outcomes in patients requiring anterior cranial base resection for SNM.

Methods: Patients >18 years old were queried on the TriNetX platform based on diagnosis of SNM (ICD C30.0) and CPT codes for anterior cranial base resection of primary malignancy and neck dissection. Patients who received neck dissection were subsequently grouped based on the timing of neck dissection (same day as primary resection, between 1-30 days after primary resection, or between 30 and 90 days after primary resection). Propensity score matching for age at sinonasal malignancy diagnosis, TNM staging, and common comorbidities including hypertension, type 2 diabetes, and tobacco use was used to generate equal cohorts. Kaplan-Meier survival, instances of emergency room encounters, and instances of adjuvant radiotherapy were analyzed.

Results: 1452 patients were found on the database with a diagnosis of SNM and underwent an anterior cranial base resection, with 123 patients undergoing neck dissection within 90 days of primary resection. 68.2% (84) patients had neck dissection on the same day as primary resection, 16.3% (20) patients between 1-30 days after primary resection, and 15.4% (19) patients with neck dissection between 30 and 90 days from primary resection. There was no significant difference in overall survival for patients who received neck dissection on the same day as primary resection versus within 30 days (p = 0.8421), as well as incidence of ER visits (p = 1.000). There was no significant difference in overall survival between patients who had neck dissection within 30 days from primary resection versus after 30 days (p = 0.2083), with a trend towards lower survival in those with later neck dissection. There was no significant difference in incidence of ER visits between patients with neck dissection within 30 days versus after 30 days (p = 0.7971). There were also no significant differences in instances of adjuvant radiotherapy between patients who had neck dissection on the same day versus within 30 days of primary resection (p = 0.9888), same day versus between 30 and 90 days (p = 0.1841), and within 30 days of primary resection versus after 30 days (p = 0.3007).

Discussion: This is the first study examining the timing of neck dissection in the setting of sinonasal malignancy treated with primary surgical resection including anterior cranial base resection. A majority of patients underwent a neck dissection on the same day as primary resection. Patients who underwent neck dissection greater than 30 days after primary resection do not appear to have worse outcomes than those with earlier neck dissection.

 

MissingLinkText

Die Autoren geben an, dass kein Interessenkonflikt besteht.

Publikationsverlauf

Artikel online veröffentlicht:
05. Februar 2024