TY - JOUR
T1 - Effect of Piecemeal vs En Bloc Approaches to the Lateral Temporal Bone on Survival Outcomes
AU - Muelleman, Thomas
AU - Chowdhury, Naweed I.
AU - Killeen, Daniel
AU - Sykes, Kevin
AU - Kutz, J. Walter
AU - Isaacson, Brandon
AU - Staecker, Hinrich
AU - Lin, James
N1 - Publisher Copyright:
© 2018, © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2018.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Objectives: Lateral temporal bone resection (LTBR) has traditionally been performed en bloc in accordance with oncologic principles. Occasionally, this is not possible due to a low tegmen or lateralized vasculature. We sought to determine if outcomes of piecemeal and en bloc LTBR are comparable. Study Design: Retrospective review. Setting: Two academic medical centers. Subjects and Methods: Multi-institutional retrospective cohort study. Current Procedural Terminology codes were used to identify patients with T1 to T3 squamous cell carcinoma of the external auditory canal (EAC) who underwent LTBR from 2005 to 2015. Kaplan-Meier curves were constructed to compare total survival between the 2 treatment approaches. Pairwise comparisons were performed using χ2 and Fisher exact tests (significance at P =.05), as appropriate. Results: Twenty-five patients were identified. Ten patients underwent en bloc LTBR; 15 underwent piecemeal LTBR. Median follow-up time was 11 months (range, 1-60 months). There was not a significant difference in overall survival between en bloc (38.9 months; 95% confidence interval [CI], 22.7-55.2) compared to piecemeal (37.5 months; 95% CI, 21.1-53.9) procedures (P =.519). Estimates of disease-free survival also did not reveal statistically significant differences: estimated mean disease-free survival was 48.1 months (95% CI, 33.7-62.6) in en bloc patients and 32.5 months (95% CI, 17.1-47.8) in piecemeal patients (P =.246). Conclusion: These data suggest that piecemeal resection can be considered for cases of squamous cell carcinoma involving the external auditory canal where anatomic constraints preclude a safe en bloc resection. Larger studies or studies with a longer follow-up time may provide improved insight into survival comparisons.
AB - Objectives: Lateral temporal bone resection (LTBR) has traditionally been performed en bloc in accordance with oncologic principles. Occasionally, this is not possible due to a low tegmen or lateralized vasculature. We sought to determine if outcomes of piecemeal and en bloc LTBR are comparable. Study Design: Retrospective review. Setting: Two academic medical centers. Subjects and Methods: Multi-institutional retrospective cohort study. Current Procedural Terminology codes were used to identify patients with T1 to T3 squamous cell carcinoma of the external auditory canal (EAC) who underwent LTBR from 2005 to 2015. Kaplan-Meier curves were constructed to compare total survival between the 2 treatment approaches. Pairwise comparisons were performed using χ2 and Fisher exact tests (significance at P =.05), as appropriate. Results: Twenty-five patients were identified. Ten patients underwent en bloc LTBR; 15 underwent piecemeal LTBR. Median follow-up time was 11 months (range, 1-60 months). There was not a significant difference in overall survival between en bloc (38.9 months; 95% confidence interval [CI], 22.7-55.2) compared to piecemeal (37.5 months; 95% CI, 21.1-53.9) procedures (P =.519). Estimates of disease-free survival also did not reveal statistically significant differences: estimated mean disease-free survival was 48.1 months (95% CI, 33.7-62.6) in en bloc patients and 32.5 months (95% CI, 17.1-47.8) in piecemeal patients (P =.246). Conclusion: These data suggest that piecemeal resection can be considered for cases of squamous cell carcinoma involving the external auditory canal where anatomic constraints preclude a safe en bloc resection. Larger studies or studies with a longer follow-up time may provide improved insight into survival comparisons.
KW - ear canal
KW - en bloc
KW - external auditory canal
KW - lateral temporal bone resection
KW - piecemeal
KW - squamous cell carcinoma
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U2 - 10.1177/0194599818758994
DO - 10.1177/0194599818758994
M3 - Article
C2 - 29460680
AN - SCOPUS:85045014379
SN - 0194-5998
VL - 158
SP - 716
EP - 720
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 4
ER -