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

Mouriaux, Frédéric; Martinot, V.; Pellerin, P.; Patenotre, P; Rouland, Jean‐François; Constantinides, Georges

doi:10.1034/j.1600-0420.1999.770316.x

Cited by 37 publications

(33 citation statements)

References 24 publications

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“…This is lower than other case series, such as Mouriaux et al suggest that tumour-free margins have little effect on survival in patients undergoing exenteration for malignancy, due to the presence of micro-metastases early in disease. 15 Analysis of our data agrees with this view. There was no statistically significant difference in overall survival in patients with clear surgical margins post-exenteration compared to patients without clear margins (p = 0.12).…”

Section: Discussionsupporting

confidence: 93%

Orbital exenteration: The 10-year Massachusetts Eye and Ear Infirmary experience

Nagendran

Lee

Fay

et al. 2016

Orbit

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The authors report their experience with orbital exenteration surgery at one academic institution over a 10-year period and review the literature. This retrospective cohort study monitored outcomes of all patients who underwent orbital exenteration surgery at Massachusetts Eye and Ear Infirmary between January 2003 and January 2013. Patients with no follow-up data or survival data were excluded from the study. The main outcome measures were surgical complications, disease status of surgical margins, need for adjuvant treatment, local recurrence, metastases and survival. 23 patients with malignancy and 2 with mucormycosis met inclusion criteria for the study. Surgical procedures included non-lid sparing total exenteration (44%), lid-sparing total exenteration (32%), non-lid sparing partial exenteration (8%) and lid-sparing partial exenteration (16%). 44% underwent additional extra-orbital procedures. Survival rates were 72% at 1 year, 48% at 3 years, and 37% at 5 years. Of patients with malignancies, 48% had clear margins after exenteration. There was no statistically significant difference in survival between patients with negative surgical margins compared to positive margins (p = 0.12). Mortality was highest in patients with melanoma (85.7%) and lowest in patients with non-squamous cell lid malignancies (0%). Our study suggests that the type of disease has a much greater impact on the survival of patients undergoing exenteration surgery than the type of exenteration surgery or the disease status of surgical margins. Patients with non-squamous cell lid malignancies and localized orbital disease have the best prognosis for tumor eradication from this radical and highly disfiguring surgery.

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Section: Discussionsupporting

confidence: 93%

Orbital exenteration: The 10-year Massachusetts Eye and Ear Infirmary experience

Nagendran

Lee

Fay

et al. 2016

Orbit

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“…This finding confirms those of Rahman et al 4 and Mouriaux et al 7. One explanation for this finding is that despite having prevented local recurrence, micro-metastasis may have occurred prior to surgery.…”

Section: Discussionsupporting

confidence: 91%

Life expectancy following orbital exenteration

2014

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Orbital exenteration is a physically debilitating procedure that may be a necessity in the management of orbital malignancy. It requires a sensitive multidisciplinary approach, both preoperatively and postoperatively. Providing life expectancy information for patients during preoperative counselling is pertinent to informed consent and in addressing patients' expectations. A retrospective review from one tertiary care centre was undertaken for a cohort of patients who were exenterated for orbital malignancy between 1998 and 2010. The cases were identified using an International Classification of Diseases 10th Revision (ICD-10)-derived database and were analysed using Prism statistical software (V.5.04). Cause of death was ascertained by liaising with the general practitioner and the National Registrar Office for Births, Deaths, and Marriages, Southport, UK. In total, 41 men and 32 women were identified. Mean age was 72 years with 47 cases living and 26 deceased at the time of review. The overall 5-year survival rate in this study was 64%. Kaplan-Meier analysis for basal cell carcinoma (BCC) against non-BCC returned a p value of 0.0199, with an HR of 0.3927 (CI 0.1788 to 0.8626). Kaplan-Meier analysis for cleared against non-cleared margins returned a p value of 0.2890, with an HR of 0.6571(CI 0.3024 to 1.428). Our results represent the highest 5-year survival data to date. However, the overall prognosis for patients who undergo orbital exenteration for malignancy remains poor. We hypothesise that the causes are multi-factorial. We recommend a multidisciplinary approach to the care of these patients, involving head and neck teams, oncology and other appropriate specialties, to optimise outcomes for this vulnerable patient group.

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“…This is lower than the rates of positive permanent margins between 28 and 47% reported in other series. 6,17,19 One possible explanation for this is that the multidisciplinary approach to tumor resection typically used at this tertiary referral cancer center enabled additional surgical procedures to be performed at the same time as the exenteration in order to optimize tumor control. In our series, multivariate analysis showed that the presence of a positive final surgical margin was the only potential factor that was associated with a worse prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, positive final surgical margins have not been associated with a worse prognosis in other series. 6,17 It may be hard to compare numbers between different retrospective series because of the heterogeneity of inclusion criteria. This is possibly due to lower overall rates of positive margins in this series as mentioned above, as well as higher rate of micrometastasis of other tumor types such as melanoma, malignant sarcomas, adenoid cystic carcinoma, sinonasal tumors, primary orbital tumors, and lacrimal tumors, which were not included in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Clear margin status, however, has previously not been associated with improved prognosis in patients undergoing exenteration for malignancies with orbital invasion. 6,17,18 However, these studies represent a significant mix of histologic subtype (including melanoma) and site of origin (including sinonasal and primary orbital). Due to the relative rarity of orbital invasion in periorbital skin cancers, there are few reported studies that specifically examine orbital exenteration for non-melanoma malignancies arising from periocular tissue, and none that address prognostic factors and survival in this group.…”

Section: Introductionmentioning

confidence: 99%

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

Cited by 37 publications

References 24 publications

Orbital exenteration: The 10-year Massachusetts Eye and Ear Infirmary experience

Orbital exenteration: The 10-year Massachusetts Eye and Ear Infirmary experience

Life expectancy following orbital exenteration

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

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