RESUMEN
INTRODUCTION: Malignant sinonasal tumors are very rare in Mexico. They ussually present as advanced disease because it is extremely difficult to make an early diagnosis; in addition, its treatment is complicated by a variety of lesions. Surgical resection remains the mainstay of treatment, but its relative therapeutic value compared with alternative treatments is controversial. OBJECTIVE: We undertook a retrospective analysis in order to evaluate results of craniofacial resections for sinonasal tumors. MATERIALS AND METHODS: A total of 20 patients, 11 men and 9 women were considered, median age was 49 years (18-74). Eleven had received previous treatment elsewhere. In 13 patients tumor was limited to maxillo-ethmoid complex, but in 6 cases tumor involved anteroinferior aspect of sphenoid sinus, in 7 extended to the orbit, in 3 to dura and two to the brain. One had cervical metastases. Median tumoral size was 5.8 cm (1-10). RESULTS: Overall complication rate was 50%. Major surgical complications occurred in 4 patients (20%): one patient developed isolated cerebrospinal fluid leakage (CEFL), 1 developed deterioration of mental status, and two developed meningitis associated with CEFL. Late complications occurred in 30% of the patients. There was not any operative death. Eleven patients received postoperative radiotherapy. Fifteen patients recurred. There were 11 local relapses, although one associated with a regional relapse, and another with regional and distant relapse. There were four isolated regional fails and six isolated distant failures. Three year overall survival was 65%, and 3-year disease free survival was 50%. Patients without previous treatment median survival was 28.3 months, meanwhile with previous treatment was 18.2 months. CONCLUSIONS: Craniofacial resection is a safe and valuable tool in the treatment of advanced sinonasal tumors involving cranial base.
Asunto(s)
Neoplasias Nasales/cirugía , Neoplasias de los Senos Paranasales/cirugía , Adolescente , Adulto , Anciano , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/cirugía , Terapia Combinada , Duramadre/cirugía , Senos Etmoidales/cirugía , Femenino , Humanos , Masculino , Neoplasias del Seno Maxilar/cirugía , Neoplasias Meníngeas/secundario , Neoplasias Meníngeas/cirugía , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Neoplasias Nasales/radioterapia , Neoplasias Orbitales/secundario , Neoplasias Orbitales/cirugía , Neoplasias de los Senos Paranasales/radioterapia , Radioterapia Adyuvante , Estudios Retrospectivos , Terapia Recuperativa , Seno Esfenoidal/cirugía , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
A group of forty patients with generalized peritonitis was studied comparing their clinical evolution and mortality with the plasma coloidosmotic pressure values (COP). Twentynine patients survived without complications (Group I) this patients had the higher mean COP values, 17.56 mm Hg at the beggining and 19.06 mm Hg at the end of the study. Three patients showed complications directly related with peritonitis but finally survived (Group II). Their mean COP values were 16.08 mm Hg at the beggining and 13.44 mm Hg at the end. Eight patients died (Group III) lower mean COP values were obtained in this group; 13.5 at the begging and 11.94 at the end. Despite the same kind of medical and surgical treatment, response was very different in each group. Lower values of COP were found as clinical avolution worsened. A very low inicial value or failure to raise it despite the treatment may be considered as a bad prognosis sing.