Orbital exenteration: Surgical and reconstructive strategies

Mohr, Christopher; Esser, Joachim

doi:10.1007/bf01739638

Cited by 68 publications

(33 citation statements)

References 36 publications

(40 reference statements)

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“…The major criticism is that the recurrent tumor may be masked by the flap. This argument does not seem to be valid in light of the low rate of intraorbital recurrence (Mohr & Esser 1997). Moreover, in our experience, local recurrences appeared on Fig.…”

Section: Discussioncontrasting

confidence: 56%

Survival after malignant tumors of the orbit and periorbit treated by exenteration

Mouriaux

Martinot

Pellerin

et al. 1999

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: In order to further assess the survival value of orbital exenteration in malignant orbital and periorbital tumors. Methods: The charts of 44 patients exenterated for a neoplasm of the orbit or periorbit were reviewed in a retrospective study. Results:The overall 4-year survival was 45%. 26 patients had free margins on histological examination and 24 patients had developed local recurrence or metastasis. Local recurrence or metastasis were significantly more common in the group with transected margins than in the group with free-margins (pΩ 0.01). Survival between the group of patients with local recurrence or metastasis and the group without local recurrence or metastasis showed statistically significant difference (pΩ0.0025). In contrast, survival between the group of patients with free margins and the group with transected margins did not show statistically significant difference (pΩ0.13). Conclusion: Surgical free margins section is a key element in successful cancer surgery but seems not the only prognosis variable.

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Section: Discussioncontrasting

confidence: 56%

Survival after malignant tumors of the orbit and periorbit treated by exenteration

Mouriaux

Martinot

Pellerin

et al. 1999

Acta Ophthalmologica Scandinavica

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“…12,18,21,22 This is likely because advanced cases of periorbital skin cancer are managed at our institution in a multidisciplinary fashion.…”

Section: Discussionmentioning

confidence: 99%

Orbital exenteration for advanced periorbital non-melanoma skin cancer: prognostic factors and survival

Gerring

Ott

Curry

et al. 2016

Eye

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Purpose To describe prognostic factors and survival outcomes in patients who underwent orbital exenteration for periocular nonmelanoma cutaneous malignancies. Methods The authors performed an institutional review board-approved retrospective review of all patients who underwent orbital exenteration for nonmelanoma periocular cutaneous malignancies at a tertiary care hospital system over a 10-year period. Patient demographics, tumor, and treatment data were recorded. Survival outcomes included disease-free survival (DFS) and overall survival (OS). Log-rank tests were used to test for difference in survival curves among various potential prognostic indicators, and multivariate analysis was performed using Cox's proportional hazards model. Results Forty-nine patients with an average age of 70.3 years were followed with a median follow-up of 17.5 months. At 2 years the OS was 78% while the DFS was 61%. The mean DFS for basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and sebaceous gland carcinoma (SGC) were 52.6, 39.2 and 28.1 months, respectively. Multivariate analysis demonstrated that only positive final surgical margin was predictive of worse outcome (P = 0.002). Recurrences were most frequent in the first 2 years. Conclusions Despite the relatively more aggressive nature of periocular malignancies that have invaded the orbit, orbital exenteration offers an overall 2-year DFS of 60%. BCC had the greatest mean survival time, however this was not statistically significant. We found worse prognosis with positive final surgical margins and recommend a multidisciplinary surgical approach to achieve complete resection when indicated.

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“…1,3,4 If the bone of the orbit is invaded, an 'extended' exenteration is required that includes resection of diseased bone. 4,5 …”

Section: Introductionmentioning

confidence: 99%

Orbital exenteration for invasive skin tumours

Tyers

2006

Eye

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Orbital exenteration aims at local control of disease invading the orbit that is potentially fatal or relentlessly progressive. Of all exenterations presenting to ophthalmologists, 40-50% are required for tumours in the eyelid or periocular skin. 99% of these are basal cell carcinomas and 4-6% each are squamous cell carcinomas or sebaceous gland carcinomas. Orbital invasion results in progressive fixation of the tumour to bone and reduced ocular motility. Perineural invasion of branches of the trigeminal nerve leads to numbness or pain, and that the facial nerve, to weakness. Biopsy identifies the cell type and the presence of perineural invasion. CT and MRI scanning help in the assessment of tumour spread within the orbit. Management should be in collaboration with an oncologist. Exenteration may be totalthe removal of all orbital contents-or lidsparing if the tumour is placed posteriorly. The socket may be allowed to heal by granulation or lined with a split skin graft or local flap. Complications may be seen following 20-25% of exenterations and include fistulae, tissue necrosis, exposed bone, and infection. Incomplete clearance of tumours occurs in about 38% of total exenterations and 17% of subtotal. The overall 5-year survival is 55-65%, but significantly worse if there was perineural spread. Facial prostheses may be mounted on glasses or secured with tissue glue or osseointegrated implants. Excellent cosmetic results can be achieved but many patients prefer to wear a patch.

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Orbital exenteration: Surgical and reconstructive strategies

Abstract: Detailed consideration of all clinical and histological findings is essential before surgery, in order to prevent a higher rate of recurrence following these modified operations.

Cited by 68 publications

References 36 publications

Survival after malignant tumors of the orbit and periorbit treated by exenteration

Survival after malignant tumors of the orbit and periorbit treated by exenteration

Orbital exenteration for advanced periorbital non-melanoma skin cancer: prognostic factors and survival

Orbital exenteration for invasive skin tumours

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