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Ordoyne LM, Alvarez I, Borne G, Fabian I, Adilbay D, Kandula RA, Asarkar AA, Nathan CAO, Olinde L, Pang J. Risk Factors for Complications in Patients Undergoing Temporal Bone Resection and Neck Dissection: Insights From a National Database. Ann Otol Rhinol Laryngol 2024:34894241252541. [PMID: 38712888 DOI: 10.1177/00034894241252541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Temporal bone resection (TBR) with or without neck dissection (ND) is performed for otologic malignancies with occult or clinical cervical lymph node metastases. To date, characterization of post-operative complications in single institution case series may be non-representative of real-world outcomes. Here, we used data from the National Inpatient Sample (NIS) to comprehensively assess the complications encountered, their frequencies, and to identify underlying risk factors to improve future outcomes. METHODS The population was patients undergoing TBR and ND derived from the NIS between the years of 2017 and 2019. We utilized ICD-10 diagnosis codes to identify patients with post-operative complications, those discharged to non-home facilities (DNHF), and those with increased length of stay (LOS). Multivariable regression was performed to identify significant variables related to the above outcomes. RESULTS Ninety of 277 patients that underwent LTBR with ND had postoperative complications. Wound complications were the most frequent complication, occurring in 11 (4%) of patients, followed by CSF leak (n = 6; 2.2%), with acute respiratory failure being the most common medical complication (n = 4; 1.4%). Sixteen percent (45/277) were discharged to a facility besides home. Dementia (OR = 7.96; CI95 3.62-17.48), anemia (OR = 2.39; CI95 1.15-4.99), congestive heart failure (OR = 5.31; CI95 1.82-15.45), COPD (OR = 3.70; CI95 1.35-10.16), and history of prior stroke (OR = 8.50; CI95 1.55-46.68) increased the odds of DNHF. When evaluating LOS (median = 5 days, IQR = 1, 9), anemia (OR = 5.49; CI95 2.86-10.52), and Medicaid insurance (OR = 3.07; CI95 1.06-10.52) were found to increase the LOS. CONCLUSIONS The vast majority of patients undergoing LTBR with ND have no complications and are discharged within a week. Liver disease is a risk factor for medical complications and increased charges. Patients with dementia or a prior stroke are at risk for DNHF, and those with prior anemia are at risk for a wound complication. LAY SUMMARY This study identified factors related to worse post-operative outcomes in patients undergoing temporal bone resection and neck dissection. Although safe for most patients, an existing diagnosis of liver disease, stroke, dementia, and anemia specifically are at risk for developing negative outcomes. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Liam M Ordoyne
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
| | - Ivan Alvarez
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
| | - Grant Borne
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
| | - Isabella Fabian
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
| | - Dauren Adilbay
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
| | - Rema A Kandula
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
| | - Ameya A Asarkar
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
- Feist Weiller Cancer Center, Shreveport, LA, USA
| | - Cherie-Ann O Nathan
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
- Feist Weiller Cancer Center, Shreveport, LA, USA
| | - Lindsay Olinde
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
- Feist Weiller Cancer Center, Shreveport, LA, USA
| | - John Pang
- Department of Otolaryngology-HNS, LSU Health Sciences Center, Shreveport, LA, USA
- Feist Weiller Cancer Center, Shreveport, LA, USA
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Huang Y, Wu J, Chao W, Lee W. Treatment outcome and prognostic factors of external auditory canal squamous cell carcinoma: A retrospective study in a tertiary center. Laryngoscope Investig Otolaryngol 2024; 9:e1216. [PMID: 38362177 PMCID: PMC10866593 DOI: 10.1002/lio2.1216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/27/2023] [Accepted: 12/26/2023] [Indexed: 02/17/2024] Open
Abstract
Objective Squamous cell carcinoma (SCC) of the external auditory canal (EAC) is a rare malignancy with various treatment strategies and outcomes. The purpose of this study was to evaluate the clinical characteristics and survival outcomes and identify prognostic factors in patients with SCC of EAC. Methods Twenty-one patients with SCC of EAC treated in a single tertiary center between 2009 and 2021 were retrospectively reviewed and analyzed. The modified Pittsburgh classification system was applied for staging. Factors associated with survival were identified by univariate survival analysis. Results The mean age at diagnosis was 61 years (range: 41-79 years). Early-stage (T1 + T2) accounts for 38.1% of the series and advanced-stage (T3 + T4) accounts for 61.9%. Eighteen (85.7%) patients underwent primary surgery with curative intent. The 5-year overall survival rate of the 21 patients was 67.4%. Tumor invasion to the otic capsule, eustachian tube, sigmoid sinus, and dura were associated with poor prognosis in univariate analysis (p = .046; .008; .027; and .08, respectively). Conclusions Factors predictive of less favorable survival include the history of COM, tumor invasion to the otic capsule, eustachian tube, sigmoid sinus, and dura. It is important to make a precise and systemic preoperative evaluation of disease extent. Level of Evidence 4.
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Affiliation(s)
- Yi‐Ting Huang
- Department of OtolaryngologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainan CityTaiwan
| | - Jiunn‐Liang Wu
- Department of OtolaryngologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainan CityTaiwan
| | - Wen‐Yuan Chao
- Department of OtolaryngologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainan CityTaiwan
| | - Wei‐Ting Lee
- Department of OtolaryngologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainan CityTaiwan
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Samara P, Athanasopoulos M, Goulioumis A, Athanasopoulos I. Malignant tumors of the external auditory canal: diagnosis, treatment, genetic landscape, biomarkers, and clinical outcome. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2023; 4:801-811. [PMID: 37970205 PMCID: PMC10645464 DOI: 10.37349/etat.2023.00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/13/2023] [Indexed: 11/17/2023] Open
Abstract
Malignant tumors of the external auditory canal (EAC) are rare neoplasms that appear in the head and neck area. A common feature of these malignancies is their rarity, as well as their delayed diagnosis due to the appearance of non-specific symptoms that mimic various benign otologic conditions. The reported histological types of cancer of the external ear are: squamous cell carcinoma, basal cell carcinoma, malignant melanoma, Merkel cell carcinoma, angiosarcoma, adnexal carcinoma (including ceruminous adenocarcinoma and adenoid cystic carcinoma), and lymphoma (Lancet Oncol. 2005;6:411-20. doi: 10.1016/S1470-2045(05)70208-4). Several therapeutic interventions have been proposed, primarily orientated towards the cure of the patient, placing the surgical excision of the lesions at the tip of the spear. Subsequently and depending on the clinical stage and the pathological characteristics of the tumor, radiation, chemotherapy, a combination thereof, or some form of palliative treatment for particularly advanced cases, may be recommended. The aim of all the above-mentioned approaches is the complete resection of the mass with negative surgical margins along with lymph node dissection, the elimination of any residual disease or metastasis, and the improvement of survival. The anatomical complexity of the region will always remain a demanding challenge. Nevertheless, advances in the fields of ear microsurgery, imaging, radiation, molecular biology, and genomics have led to remarkable outcomes compared to the past, with a view to the patient's quality of life. Large, well-organized, and prospective studies with the participation of multiple centers in contrast to existing retrospective studies with a limited number of patients will help to establish universally accepted guidelines. The exploration of the molecular and genetic background of these cancers in conjunction with the search for new biomarkers and target molecules seems promising for providing upgraded and more personalized treatment modalities for the future.
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Affiliation(s)
- Pinelopi Samara
- Children’s Oncology Unit Marianna V. Vardinoyannis-ELPIDA, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
| | - Michael Athanasopoulos
- Otolaryngology-Head and Neck Surgery, Karamandaneio Pediatric Hospital, 26331 Patras, Greece
| | - Anastasios Goulioumis
- Otolaryngology-Head and Neck Surgery, Karamandaneio Pediatric Hospital, 26331 Patras, Greece
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Komune N, Kuga R, Hongo T, Kuga D, Sato K, Nakagawa T. Impact of Positive-Margin Resection of External Auditory Canal Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:4289. [PMID: 37686564 PMCID: PMC10486369 DOI: 10.3390/cancers15174289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Positive-margin resection of external auditory canal squamous cell carcinoma (EAC-SCC) is still a major cause of recurrence. The aim of this study is to examine the clinical impact of positive-margin resection of EAC-SCCs. METHODS We retrospectively reviewed 40 surgical cases with en bloc temporal bone resection of EAC-SCC at a tertiary referral center from October 2016 to March 2022. RESULTS Two-year disease-specific, overall, and disease-free survival rates for all 40 cases reviewed were 85.2%, 88.85%, and 76.96%, respectively. En bloc resection with a negative margin significantly improved patient prognosis (p < 0.001). Positive-margin resection was observed in 9/40 cases (22.5%). Insufficient assessment of preoperative images was the cause in two of these cases. Postoperative lymph node metastasis and distant metastasis were observed in cases in which vascular, lymphatic duct or perineural invasion was found on postoperative pathological examination. In addition, three cases in which no vascular, lymphatic duct, or perineural invasion was found exhibited local recurrence during the follow-up period. Of the nine positive-margin resection cases, only two showed no postoperative recurrence. CONCLUSIONS Once positive-margin resections are confirmed, cases might have a high risk of tumor recurrence, even with the addition of postoperative adjuvant chemoradiotherapy.
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Affiliation(s)
- Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (R.K.); (T.H.); (K.S.); (T.N.)
| | - Ryosuke Kuga
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (R.K.); (T.H.); (K.S.); (T.N.)
- Department of Anatomic Pathology, Pathological, Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Takahiro Hongo
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (R.K.); (T.H.); (K.S.); (T.N.)
| | - Daisuke Kuga
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan;
| | - Kuniaki Sato
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (R.K.); (T.H.); (K.S.); (T.N.)
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (R.K.); (T.H.); (K.S.); (T.N.)
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Cazzador D, Franz L, Tealdo G, Carobbio ALC, Ferraro M, Mazzoni A, Marioni G, Zanoletti E. Survival Outcomes in Squamous Cell Carcinoma of the External Auditory Canal: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072490. [PMID: 37048574 PMCID: PMC10094887 DOI: 10.3390/jcm12072490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Squamous cell carcinomas (SCC) of the external auditory canal (EAC) are rare tumors representing a surgical challenge. Current knowledge is based largely on case series; thus, the level of evidence is weak. This study sought to systematically review the available SCC of the EAC literature and to identify risk factors for overall survival (OS) and disease-specific survival (DSS). A systematic review and meta-analysis of papers searched up to December 2022 through PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted. Quality assessment of the eligible studies was done according to the Newcastle-Ottawa Scale. Pooled univariate and multivariable analyses and meta-analysis using a random-effects or fixed-effects Mantel-Haenszel model were performed. Fifteen articles (282 patients) met the inclusion criteria and were included in the quantitative analysis. The pooled multivariable analysis revealed cT3 and cT4 as independent prognostic factors for OS (p = 0.005, and p < 0.001, respectively) and DSS (p = 0.002, and p < 0.001, respectively). Local recurrence rate was 32.3%. The meta-analysis estimated significantly higher odds ratios for advanced T categories, than cT1-T2 tumors for OS and DSS (OR = 3.55; 95% CI, 1.93–6.52, and OR = 3.73; 95% CI, 2.00–6.97, respectively). In conclusion, locally advanced tumors were associated with poor prognosis. Poor outcomes mostly occurred due to local recurrence.
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Zheng Y, Qiu K, Fu Y, Yang W, Cheng D, Rao Y, Mao M, Song Y, Xu W, Ren J, Zhao Y. Clinical outcomes of temporal bone squamous cell carcinoma: A single-institution experience. Cancer Med 2023; 12:5304-5311. [PMID: 36229984 PMCID: PMC10028158 DOI: 10.1002/cam4.5338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/24/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the survival outcomes and potential prognostic factors of patients with temporal bone squamous cell carcinoma (TBSCC) treated at our institution. METHODS We retrospectively included patients who were diagnosed with TBSCC between 2008 and 2019. The Kaplan-Meier (KM) method was used to describe overall survival (OS), and the association between baseline characteristics and prognoses was examined using Cox proportional hazards models. RESULTS Fifty consecutive patients with TBSCC were included in this study. The results showed that patients with advanced modified Pittsburgh (MPB)- T classifications had a poorer prognosis (T3 vs. T1-2: HR: 2.81, 95% CI: 0.34-23.43; T4 vs. T1-2: HR: 7.25, 95% CI: 0.95-55.41; p = 0.041). Meanwhile, middle ear squamous cell carcinoma (MESCC) showed a significantly worse prognosis than external auditory canal squamous cell carcinoma (EACSCC, HR: 2.65, 95% CI: 1.04-6.76, p = 0.04). CONCLUSIONS MESCC and advanced MPB-T classifications might be considered predictors of unfavorable outcomes in patients with TBSCC, indicating that special attention should be paid to the original tumor subsite and tumor extension in the management of patients with TBSCC.
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Affiliation(s)
- Yongbo Zheng
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Qiu
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yangju Fu
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenjie Yang
- Center of Biostatistics, Design, Measurement and Evaluation(CBDME), West China Hospital, Sichuan University, Chengdu, China
| | - Danni Cheng
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yufang Rao
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Minzi Mao
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Song
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Jianjun Ren
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Zhao
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
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Laskar SG, Sinha S, Pai DP, Nair D, Budrukkar A, Swain M, Kimar A, Moiyadi A, Shetty P, Roy V, Johnny C, Murthy V, Gupta T, Menon N, Patil V, Noronha V, Joshi A, Prabhash K, Agarwal JP. Definitive and adjuvant radiation therapy for external auditory canal and temporal bone squamous cell carcinomas: Long term outcomes. Radiother Oncol 2022; 170:151-158. [DOI: 10.1016/j.radonc.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 10/19/2022]
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