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Kakati K, Das A, Nath J, Das K, Rahman T, Das AK, Das RJ. Orbital Exenteration: Tumour Diversity and Survival-Report from a Cancer Centre of Northeast India. Indian J Otolaryngol Head Neck Surg 2023; 75:3268-3276. [PMID: 37974770 PMCID: PMC10645857 DOI: 10.1007/s12070-023-03950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 11/19/2023] Open
Abstract
Orbital exenteration is a mutilating surgery which involves the removal of the entire contents of the bony orbit, including the globe, extraocular muscles and periorbital fat, and many times includes the eyelids. Since it leads to severe disfigurement, it is an infrequent procedure largely indicated in malignant conditions. The current study aims to report the clinicodemographic profile and treatment outcome of orbital exenteration patients done in a cancer care center in Northeast India. This is a hospital-based retrospective study between January 2017 and December 2021, including patients undergoing orbital exenteration. All patient and treatment-related data were retrieved from the record of hospital files. A total of 18 patients were included in the study. The mean age of the patients was 51 ± 18 years and male: female ratio was 1:1. Most patients had primary in orbit (55.6%). The most common histology was squamous cell carcinoma, (8/18, 44.4%), followed by basal cell carcinoma (two patients, 11.1%). After a median follow-up was 25 months (range 3-92), the median DFS of the study population was 31.4 months. The five-year overall survival of the patients was 54%. Orbital exenteration is an infrequent surgery due to the associated disfigurement and hence reserved for conditions where eye preservation is impossible. We tried to report the experience of orbital exenteration from a single cancer center for five years.
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Affiliation(s)
- Kaberi Kakati
- Department of Head and Neck Surgery, Dr B Borooah Cancer Institute, Guwahati, Assam 781016 India
| | - Anupam Das
- Department of Head and Neck Surgery, Dr B Borooah Cancer Institute, Guwahati, Assam 781016 India
| | - Jyotiman Nath
- Department of Radiation Oncology, Dr B Borooah Cancer Institute, Guwahati, Assam 781016 India
| | - Kishore Das
- Department of Head and Neck Surgery, Dr B Borooah Cancer Institute, Guwahati, Assam 781016 India
| | - Tashnin Rahman
- Department of Head and Neck Surgery, Dr B Borooah Cancer Institute, Guwahati, Assam 781016 India
| | - Ashok Kumar Das
- Department of Head and Neck Surgery, Dr B Borooah Cancer Institute, Guwahati, Assam 781016 India
| | - Raj Jyoti Das
- Department of Head and Neck Surgery, Dr B Borooah Cancer Institute, Guwahati, Assam 781016 India
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Nandi S, Chhebbi M, Mandal A. A Systematic Review Article on Orbital Exenteration: Indication, Complications and Reconstruction Methods. Indian J Otolaryngol Head Neck Surg 2022; 74:1183-1191. [PMID: 36452694 PMCID: PMC9702243 DOI: 10.1007/s12070-020-02270-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022] Open
Abstract
Orbital Exenteration is a major surgical procedure that consists of the removal of the orbital bone, orbital fat, eyeball, and its contents including extraocular muscles. It is an extensive and morbid surgical procedure. Our aim is to systematically review the indications, complications and reconstruction methods utilised for orbital exenteration. An objective electronic database search was conducted in PUBMED Central, MeSH, NLM Catalog, Bookshelf, and PUBMED published in 20 years period from 1999 till 2019. A total of 29 articles were shortlisted for the present review. Most of the studies have eyelid and canthus as most common primary site of malignancy leading to orbital exenteration. Basal cell carcinoma and squamous cell carcinoma being most common pathology. Other intraocular pathology was Retinoblastoma and melanoma. There were various reconstruction methods used by different authors and Sino-orbital fistula was most commonly occurring in majority of studies. Inspite of being a morbid surgery, Orbital Exenteration had acceptable survival and good quality of life. The aggressive pathology that requires orbital exenteration worldwide is mostly periorbital skin, sinus, and intraocular malignancies. The morbidity of the procedure is high with many surgical complications. However, in properly selected patients it can give better outcomes and survival.
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Affiliation(s)
- Sourabh Nandi
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Madiwalesh Chhebbi
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Amitabha Mandal
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
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Kim MJ, Lee MJ, Jeong WS, Hong H, Choi JW. Three-dimensional computer modeling of standard orbital mean shape in Asians. J Plast Reconstr Aesthet Surg 2020; 73:548-555. [DOI: 10.1016/j.bjps.2019.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/11/2019] [Accepted: 09/20/2019] [Indexed: 11/26/2022]
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Kasaee A, Eshraghi B, Nekoozadeh S, Ameli K, Sadeghi M, Jamshidian-Tehrani M. Orbital Exenteration: A 23-year Report. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:366-370. [PMID: 31389213 PMCID: PMC6685828 DOI: 10.3341/kjo.2018.0052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/11/2018] [Accepted: 07/22/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Orbital exenteration is a psychologically and anatomically disfiguring procedure which indicated in some patients with malignant or progressive diseases of orbital and periorbital area. In this study, we reviewed 176 patients that underwent orbital exenteration. METHODS This was a retrospective study of medical records from all patients who underwent orbital exenteration from March 1991 to March 2014 in oculoplastic department at an eye care center. Demographic data, diagnosis, site of primary involvement and technique of surgery were determined in patients. RESULTS One hundred seventy-six cases of orbital exenteration were included that had documented histopathology. The age of patients ranged from 1 to 91 years (mean age ± standard deviation, 55.43 ± 27 years). Ninety-seven (55.11%) males and 79 (44.88%) females were included. Fifteen different tumors were identified. The most common indication was patients with basal cell carcinoma 49 (28%) followed by 41 (23.5%) squamous cell carcinomas, 35 (20%) retinoblastoma, and 13 (7%) adenoid cystic carcinomas. In total, adnexal malignancies were the most common tumors, secondarily involving the orbit. Eyelids 89 (50.5%) and the globe 43 (24%) were the most frequent site of involvement. Three types of exenteration were performed, based on available data of 129 operation sheets, 46 (35.7%) subtotal, 62 (48.1%) total, and 21 (16.3%) cases of extensive exenterations. In total 97 cases were evaluated pathologically for perineural involvement, of which perineural invasion was noted in 9 (7%) reports. CONCLUSIONS Frequency of exenteration in our center has increased in past 3 years and the majority of cases were eyelid basal cell carcinoma. Patient education considering periocular lesions can help in earlier diagnosis of malignant lesions and therefore reducing the number of exenteration.
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Affiliation(s)
- Abolfazl Kasaee
- Ophthalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Eshraghi
- Ophthalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahbaz Nekoozadeh
- Ophthalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Ameli
- Ophthalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Motahareh Sadeghi
- Ophthalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansooreh Jamshidian-Tehrani
- Ophthalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Ben L, Aemero M, Gushchin AG, Moore GH, Rohit S. Clinico-Pathological Patterns of Patients Who Underwent Orbital Exenteration in a Tertiary Eye Hospital of Nepal. Ethiop J Health Sci 2017; 26:543-548. [PMID: 28450769 PMCID: PMC5389073 DOI: 10.4314/ejhs.v26i6.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Orbital exenteration is a destructive procedure performed by removing all or part of the orbital contents along with entire eyeball. It is a procedure reserved for life threatening malignancies and some nonmalignant disorders which are not controlled by conservative management. Methods This is a retrospective study done on patients who underwent orbital exenteration at Tilganga Institute of Ophthalmology from1 January 2006– 30 in December 2014. Results The mean age of patients was 30 years (range 1–78), with male preponderance of 15(55.6%. Overall presenting duration of eye morbidity was 18 months (2 months–8.5 years). The most common presenting complaint was protrusion of eyeball1, 4(50%), primary site of tumor being intraocular in 10 patients (35.7%,) and total orbital exenteration was the most commonly performed type of surgery in 16(57.1%) out of 27 patients. The most common etiology responsible for orbital exenteration, in pediatric age group of 9/27 patients (64.2%), was retinoblastoma whereas conjunctival squamous cell carcinoma (SCC)accounts for 5 patients (38.4%) in adults. Overall, the most common cause of orbital exenteration was retinoblastoma 9(32.1%). Conclusion The most common etiologies requiring orbital exenteration were retinoblastoma (in children and overall) and conjunctival squamous cell carcinoma (in adults), both diseases that could be addressed with less invasive treatment modality if detected earlier in the disease process. Designing strategy is important for early detection and treatment of these conditions, which would decrease disease morbidity and prognosis, potentially sparing sight and life.
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Affiliation(s)
- Limbu Ben
- Tilganga Institute Of Ophthalmology, Nepal
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Hoffman GR, Jefferson ND, Reid CBA, Eisenberg RL. Orbital Exenteration to Manage Infiltrative Sinonasal, Orbital Adnexal, and Cutaneous Malignancies Provides Acceptable Survival Outcomes: An Institutional Review, Literature Review, and Meta-Analysis. J Oral Maxillofac Surg 2015; 74:631-43. [PMID: 26475973 DOI: 10.1016/j.joms.2015.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Orbital exenteration (OE) is an aggressive operative undertaking that results in a disfiguring and dysfunctional outcome for patients. The purpose of our study was to determine the survival outcome for patients who underwent OE for malignant disease that had invaded the orbit. MATERIALS AND METHODS We conducted an ambispective cohort study based on a review of the records of 31 consecutive patients who had undergone OE within John Hunter Hospital. The study period was 2006 to 2013. The predictor variables were the demographic, tumor site, and clinicopathologic characteristics that might influence survival. The secondary outcome variable was survival. Descriptive statistics were calculated for the categorical and continuous variables. Kaplan-Meier estimates of the survival distribution were plotted. We also performed a review of published studies and a meta-analysis to investigate the nature of OE performed by various surgical disciplines. RESULTS Of the 31 patients included in the present study, 24 were men and 7 were women. The mean age was 65 years. Of the 31 cases, 15 were squamous cell carcinoma, 8 were basal cell carcinoma, and 8 were a mixture of other pathologic types. The time to median (50%) survival for all patients was 78.4 months. The 1-year survival rate was 93.4% and the 5-year survival rate was 54.1%. Although not statistically significant, notable differences were found in the interval to death with respect to the identification of perineural invasion, lymphovascular invasion, and histopathologic features. The review of published studies suggested a difference in the histologic features and location of the disorder treated, the extent of OE undertaken, and the method of reconstruction between the ophthalmology and nonophthalmology surgical disciplines. CONCLUSIONS Although OE results in significant disfigurement and dysfunction, it does provide good survival outcomes, given the extent of disease at presentation, evident in our group of patients. Continuation of the study, with greater numbers of patients, will serve to increase the statistical power of our observations.
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Affiliation(s)
- Gary Russell Hoffman
- Visiting Medical Officer (Attending Surgeon), Division of Oral-Maxillofacial-Head and Neck Surgery, Head and Neck Surgeon, and Head, Department of Maxillofacial Surgery, John Hunter Hospital, and Conj. Associate Professor, University of Newcastle Medical School, New South Wales, Australia.
| | - Niall David Jefferson
- Visiting Medical Officer (Attending Surgeon), Division of Otorhinolaryngology, Head and Neck Surgeon, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Colin Bruce A Reid
- Visiting Medical Officer (Attending Surgeon), Division of Otorhinolaryngology, Head and Neck Surgeon, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Robert Leonard Eisenberg
- Visiting Medical Officer (Attending Surgeon), Division of Otorhinolaryngology, Head and Neck Surgeon, John Hunter Hospital, Newcastle, New South Wales, Australia
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Ali MJ, Pujari A, Dave TV, Kaliki S, Naik MN. Clinicopathological profile of orbital exenteration: 14 years of experience from a tertiary eye care center in South India. Int Ophthalmol 2015; 36:253-8. [PMID: 26249131 DOI: 10.1007/s10792-015-0111-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 08/04/2015] [Indexed: 02/06/2023]
Abstract
This study aims to describe the clinicopathological features and outcomes of patients who underwent orbital exenteration at a tertiary eye care center in south India. Retrospective chart reviews were performed on all patients undergoing orbital exenteration from January 1999 to December 2012. Parameters recorded include demographic data, clinical presentations, past medical or surgical interventions, exenteration notes, histopathological diagnosis, adjunctive treatment, follow-up examination findings, recurrences, complications, and their management. Orbital exenteration was performed on 119 orbits of 119 patients over a 14-year period. The mean age was 48.9 years (range 1-82 years). The indications were malignancies in 90.7 % (108/119), while 9.3 % (11/119) of cases were exenterated for non-malignant indications. Among the malignancies, the commonest tissue of origin was conjunctiva, noted in 45.4 % (49/108), followed by eyelids (25.9 %, 28/108), orbit (19.4 %, 21/108), and intraocular tissues (9.3 %, 10/108). The commonest malignancies noted in this series were an extensive ocular surface squamous neoplasia (OSSN) (44.4 %, 48/108) and sebaceous gland carcinoma of eyelids with an orbital involvement (18.5 %, 20/108). Extensive fungal granuloma (mucormycosis-4, aspergillosis-4) was the commonest (81.8 %, 9/11) indication among the non-malignant group. All complications were wound related, and none had a recurrence at a mean follow-up of 12.8 months. Extensive orbital involvement with OSSN and SGC were the commonest indications for exenteration. There is a need of creating awareness among general ophthalmologists in specific geographical regions regarding early diagnosis, standardized protocols of management, and appropriate referral.
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Affiliation(s)
- Mohammad Javed Ali
- Ophthalmic Plastics Surgery Service, L.V.Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad, 34, India.
| | - Aditi Pujari
- Ophthalmic Plastics Surgery Service, L.V.Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad, 34, India
| | - Tarjani Vivek Dave
- Ophthalmic Plastics Surgery Service, L.V.Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad, 34, India
| | - Swathi Kaliki
- Ophthalmic Plastics Surgery Service, L.V.Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad, 34, India
| | - Milind N Naik
- Ophthalmic Plastics Surgery Service, L.V.Prasad Eye Institute, Road No 2, Banjara Hills, Hyderabad, 34, India
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Abstract
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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Affiliation(s)
| | | | - Anne Cook
- Manchester Royal Eye Hospital, Manchester, UK
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