Risk of Incisional Recurrence after Midface and Anterior Skull Base Surgery in Sinonasal Malignancies

ABSTRACT

We sought to determine the risk of tumor incisional recurrence in patients receiving surgery and postoperative radiation therapy for locally advanced sinonasal malignancies. Medical records for 70 patients newly diagnosed with nonmetastatic American Joint Committee on Cancer stage II to stage IV sinonasal malignancies between 1991 and 2003 were retrospectively reviewed. Patient demographics and tumor variables were recorded. All patients underwent upfront surgical resection with postoperative three-dimensional conformal proton beam radiotherapy. Recurrence and survival-related outcomes were recorded. Two patients with squamous cell carcinoma had pathologically confirmed tumor recurrence at the incision site. The actuarial risk of incisional recurrence for the entire group at 1 year was 3%. One of the two patients had a maxillary sinus tumor and developed isolated skin recurrence along the transfacial incision. The other patient with an ethmoid sinus tumor developed isolated dural recurrence along the craniotomy incision. Both patients underwent multiple courses of salvage surgery and radiation therapy. One was successfully salvaged locally but developed distant metastases and the other died of local recurrence. Tumor seeding following transfacial and craniotomy surgery can occur, especially for squamous cell carcinoma. Sound oncological surgical technique, even when utilizing these difficult surgical approaches, is important to minimize incisional recurrence.

Incisional recurrence - wound metastasis - tumor implantation - anterior skull base surgery - transfacial surgery

REFERENCES

• 1 Rosen T. Cutaneous metastases.  Med Clin North Am. 1980;  64 885-900
• 2 Joshi S C, Sharma D N, Khurana N, Mohanta P K, Bahadur A K. Endometrial carcinoma with recurrence in the incisional scar: a case report.  Int J Gynecol Cancer. 2003;  13 901-903
• 3 Srivastava K, Singh S, Srivastava M, Srivastava A N. Incisional skin metastasis of a squamous cell cervical carcinoma 3.5 years after radical treatment—a case report.  Int J Gynecol Cancer. 2005;  15 1183-1186
• 4 Chen T P, Liu H P, Lu H I, Hsieh M J, Liu Y H, Wu Y C. Incidence of incisional recurrence after thoracoscopy.  Surg Endosc. 2004;  18 540-542
• 5 Reilly W T, Nelson H, Schroeder G, Wieand H S, Bolton J, O'Connell M J. Wound recurrence following conventional treatment of colorectal cancer. A rare but perhaps underestimated problem.  Dis Colon Rectum. 1996;  39 200-207
• 6 Rafii A, Ferron G, Lacroix-Triki M, Dalenc F, Gladieff L, Querleu D. Abdominal wall metastasis of ovarian carcinoma after low transverse abdominal incision: report of two cases and review of literature.  Int J Gynecol Cancer. 2006;  16 (Suppl 1) 334-337
• 7 Hu J B, Sun X N, Xu J, He C. Port site and distant metastases of gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography.  World J Gastroenterol. 2008;  14 6428-6431
• 8 Wacke W, Hecker U, Woenckhaus C, Lerch M M. Percutaneous endoscopic gastrostomy site metastasis in a patient with esophageal cancer.  Endoscopy. 2004;  36 472
• 9 Kurdow R, Schniewind B, Delere Y, Boehle A S, Lüttges J, Doniec J M. Implantation metastasis of a hypopharyngeal carcinoma at the site of a percutaneous endoscopic gastrostomy.  Endoscopy. 2003;  35 462
• 10 Ananth S, Amin M. Implantation of oral squamous cell carcinoma at the site of a percutaneous endoscopic gastrostomy: a case report.  Br J Oral Maxillofac Surg. 2002;  40 125-130
• 11 Brady L W, O'Neill E A, Farber S H. Unusual sites of metastases.  Semin Oncol. 1977;  4 59-64
• 12 Bolli J A, Doering D L, Bosscher J R et al.. Squamous cell carcinoma antigen: clinical utility in squamous cell carcinoma of the uterine cervix.  Gynecol Oncol. 1994;  55 169-173
• 13 Hughes E S, McDermott F T, Polglase A L, Johnson W R. Tumor recurrence in the abdominal wall scar tissue after large-bowel cancer surgery.  Dis Colon Rectum. 1983;  26 571-572
• 14 Gunderson L L, Sosin H, Levitt S. Extrapelvic colon—areas of failure in a reoperation series: implications for adjuvant therapy.  Int J Radiat Oncol Biol Phys. 1985;  11 731-741
• 15 Gunderson L L, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy.  Cancer. 1974;  34 1278-1292
• 16 Kotwall C A, Kirkbride P, Zerafa A E, Murray D. Endometrial cancer and abdominal wound recurrence.  Gynecol Oncol. 1994;  53 357-360
• 17 Malfetano J H. Skin metastases from cervical cancer: a fatal event.  Gynecol Oncol. 1986;  24 177-182
• 18 Fischbein N J, Kaplan M J, Holliday R A, Dillon W P. Recurrence of clival chordoma along the surgical pathway.  AJNR Am J Neuroradiol. 2000;  21 578-583
• 19 Fagundes M A, Hug E B, Liebsch N J, Daly W, Efird J, Munzenrider J E. Radiation therapy for chordomas of the base of skull and cervical spine: patterns of failure and outcome after relapse.  Int J Radiat Oncol Biol Phys. 1995;  33 579-584
• 20 Brownstein M H, Helwig E B. Patterns of cutaneous metastasis.  Arch Dermatol. 1972;  105 862-868