Multicentred international review of orbital exenteration and reconstruction in oculoplastic and orbit practice

Zhang, Ze; Ho, Son; Yin, Vivian T.; Varas, Gonzalo; Rajak, Saul; Dolman, Peter J.; McNab, Alan A.; Heathcote, J. G.; Valenzuela, Alejandra A.

doi:10.1136/bjophthalmol-2017-310681

Cited by 36 publications

(34 citation statements)

References 16 publications

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“…Cerebrospinal fluid leakage is the leading life-threatening complication with an incidence ranging between 0 and 13% [ 8 , 18 ]. Other known operative complications are sinus fistula and orbital haemorrhage [ 1 ] but they were not found in our study.…”

Section: Discussioncontrasting

confidence: 57%

“…Orbital exenteration is a radical and disfiguring surgical procedure mainly performed in case of orbital cancers. BCC is the most common tumour reported in the current literature [ 1 , 6 , 12 – 14 ]. In our study, however, conjunctival melanoma was the most prevalent tumour ( n = 14/25, 56%).…”

Section: Discussionmentioning

confidence: 99%

“…It consists of removing the entire orbital contents with a subperiosteal dissection. One can oppose eyelid sparing, total and enlarged orbital exenteration [ 1 , 2 ]. Orbital exenteration with eyelid sparing is to remove the entire orbital content without the eyelids and is therefore best suited for posterior orbital tumours.…”

Section: Introductionmentioning

confidence: 99%

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Orbital exenteration and conjunctival melanoma: a 14-year study at the Jules Gonin Eye Hospital

Martel

Oberic

Moulin

et al. 2020

Eye

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Purpose To report our 14-year experience with orbital exenteration and assess risk factors for poor prognosis by focusing on conjunctival melanoma. Patients and method A retrospective study was conducted in our tertiary care centre (Jules Gonin Eye Hospital, Lausanne, Switzerland) between 2003 and 2017. Inclusion criteria were patients aged ≥18 years with a follow-up >12 months, without metastatic spread at the time of surgery. Data recorded were age, gender, tumour histology, surgical technique, postoperative complications, surgical margin status, local recurrence, postoperative radiation beam therapy and metastatic status. Results Twenty-five patients with a mean age of 63.2 years (38–92) were included. Conjunctival melanoma was the most frequently identified tumour ( n = 14, 56%) followed by conjunctival squamous cell carcinoma ( n = 4, 16%), sebaceous carcinoma ( n = 3, 12%), choroidal melanoma ( n = 2, 8%) and basal cell carcinoma ( n = 2, 8%). Eighteen tumours (72%) originated from the conjunctival tissue. Clear surgical margins were achieved in 21 (84%) patients. Fourteen (56%) patients experienced distant metastases and died from metastatic spread after a mean follow-up of 52.3 months (6–120). The 1-, 3- and 5-year overall survival (OS) was 96%, 72% and 60%, respectively. In the univariate analysis, positive surgical margins, local recurrence and metachronous metastases were associated with a decreased OS ( p = 0.002, p = 0.005 and p = 0.007, respectively). In the multivariate analysis, positive surgical margins and metachronous metastases were also associated with a decreased OS ( p = 0.02 and p = 0.042, respectively). Conjunctival melanoma was not associated with a poorer prognosis ( p = 0.280). Conclusion Free surgical margins are needed to increase OS. To achieve clearer surgical margins, neoadjuvant targeted therapies/immunotherapies may be considered.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

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Orbital exenteration and conjunctival melanoma: a 14-year study at the Jules Gonin Eye Hospital

Martel

Oberic

Moulin

et al. 2020

Eye

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“…In addition, the lack of tissue coverage of his orbital defect after exenteration left his cavernous sinus and frontal dura exposed. It is commonly recommended that a vascularized flap or skin grafts be performed for all patients to protect the intracranial elements after exenteration [8]. Other risk factors for CBS include recurrence of tumor, poor nutrition, diabetes, and steroid use [9].…”

Section: Discussionmentioning

confidence: 99%

Successful Endovascular Treatment of Delayed Spontaneous Intracranial Internal Carotid Artery Blowout Following Orbital Exenteration and Radiation

Reed

Lyon

Benardete

2020

Cureus

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Most head and neck cancers require aggressive surgical resection followed by external beam radiation therapy. The carotid artery can be injured by surgery or radiation resulting in a delayed “blowout.” A patient who had undergone orbital exenteration for a lacrimal adenoid cystic carcinoma (ACC) followed by external beam radiation presented 16 years later with arterial bleeding from the orbit caused by “blowout” of the cavernous internal carotid artery (ICA). We review the literature on carotid blowout syndrome (CBS) and treatment. The patient was emergently transferred to a hybrid operating room and underwent a balloon occlusion test (BOT) and endovascular sacrifice of the ICA with no neurological deficits postoperatively. Emergent endovascular embolization is an effective treatment for an intracranial ICA blowout in this first reported case of a blowout through the orbit. Elevated radiation dose and lack of tissue coverage may put the cavernous ICA at risk for this delayed complication.

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“…When SCC occurs in periocular skin, it may spread into the orbit or metastasize to the regional lymph nodes, leading to significant mortality if not treated in time (1,8). Although the mortality of periocular SCC is low overall, extensive orbit invasive SCC may lead to the patient having to undergo orbital exenteration, which greatly affect the patient's vision and quality of life (9). Moreover, orbit invasion means a higher T stage, which has been shown to be significantly associated with local recurrence in a previous study (10).…”

Section: Introductionmentioning

confidence: 99%

Nomogram for Preoperative Estimation of Orbit Invasion Risk in Periocular Squamous Cell Carcinoma

Xie

et al. 2020

Front. Oncol.

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Importance: Orbital invasion occurs in some periocular squamous cell carcinoma (SCC), compromising surgical outcomes, and prognoses of patients. To date, however, there are no validation studies on the clinical features related to orbital invasion in patients with periocular SCC. Objective: To explore clinical features that may be associated with orbital invasion and build a model for predicting the risk of orbital invasion. Design, Setting, and Participants: In this retrospective mono-center case-control study, 90 patients with periocular SCC were treated at the Ninth People's Hospital Shanghai Jiao Tong University School of Medicine from January 2005 to August 2019. "Case" is defined as a SCC patient with orbit invasion prior to operation. "Exposure" is defined as the different sites of lesion. Main Outcomes and Measures: Clinical features, including "time to relapse after surgery," were collected. Multivariate logistic regression analysis was applied to identify the independent risk clinical features associated with orbital invasion, which was then incorporated into a nomogram. Results: Of the 90 patients included in this study, 33 patients (36.7%) had orbital invasion. 14 of the 33 orbit-invasive patients had local recurrence, while 11 of 57 orbit non-invasive patients had local recurrence, suggesting that orbital invasion is a risk factor for local recurrence. The multivariate binary logistic regression indicated that the lesions at the medial canthus [odds ratio (OR), 5.024, 95% CI, 1.409-17.912, P = 0.013], the age at diagnosis (10-years intervals; OR, 0.590, 95% CI, 0.412-0.844, P = 0.004), and bleeding in the lesion (OR, 3.480, 95% CI, 1.254-9.660, P = 0.017) were three preoperative clinical features significantly associated with orbital invasion. Conclusion: For periocular SCC, lesions at the medial canthus, the younger age of the patients at diagnosis, and bleeding in the lesion were the three main clinical features associated with orbital invasion. The risk score model for orbital invasion can act as a supportive tool for optimized clinical evaluation and treatment decisions.

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Multicentred international review of orbital exenteration and reconstruction in oculoplastic and orbit practice

Cited by 36 publications

References 16 publications

Orbital exenteration and conjunctival melanoma: a 14-year study at the Jules Gonin Eye Hospital

Orbital exenteration and conjunctival melanoma: a 14-year study at the Jules Gonin Eye Hospital

Successful Endovascular Treatment of Delayed Spontaneous Intracranial Internal Carotid Artery Blowout Following Orbital Exenteration and Radiation

Nomogram for Preoperative Estimation of Orbit Invasion Risk in Periocular Squamous Cell Carcinoma

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