Ethmoid Adenocarcinoma: Systematic Associated Skull Base Resection Improves Disease-Free Survival

Abstract

Objectives:

Ethmoid adenocarcinoma is an occupational tumor affecting woodworkers with prognosis correlated to the local control of the disease. Since 1998, we have developed a technique of skull base resection with reconstruction by exclusive transfacial approach. This method allows a resection of the cribriform plate and dura mater associated with the removal of the tumor with simplified postoperative features compared with mixed approach.

Methods:

We performed a retrospective analysis of 89 patients presenting with ethmoid adenocarcinoma from 1998 to 2010 (144 months). All patients treated with surgical removal and postoperative adjuvant radiotherapy were included. Postoperative features and oncologic outcomes were analyzed.

Results:

89 patients were treated by surgical removal of the ethmoid tumor associated or not with skull base resection by a transfacial approach. The median age was 67.6 years, and 91% were occupational woodworkers. Among these 89 patients, 71 benefited from skull base resection by transfacial approach. Disease free survival was significantly better in the skull base removal group (P = 0.009) and decreased for T4 stages (P = 0.008). Overall survival was not influenced by the surgical technique. This method provided less morbidity than mixed approach and good results of 5-years specific survival (85 %).

Conclusions:

Prognosis of ethmoid adenocarcinomas is related to local control. In our experience the transfacial approach for systematic skull base resection associated with tumor removal and reconstruction is safe, efficient, and improves local control with a low morbidity, allowing a curative treatment for a larger number of patients.