title: Orbital Exenteration to Manage Infiltrative Sinonasal, Orbital Adnexal, and Cutaneous Malignancies Provides Acceptable Survival Outcomes: An Institutional Review, Literature Review, and Meta-Analysis.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: 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. Electronic address: garyhoffman_au@hotmail.com.
authors.forename: Gary Russell
authors.initials: GR
authors.lastname: Hoffman
authors.affiliation: Visiting Medical Officer (Attending Surgeon), Division of Otorhinolaryngology, Head and Neck Surgeon, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Niall David
authors.initials: ND
authors.lastname: Jefferson
authors.affiliation: Visiting Medical Officer (Attending Surgeon), Division of Otorhinolaryngology, Head and Neck Surgeon, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Colin Bruce A
authors.initials: CB
authors.lastname: Reid
authors.affiliation: Visiting Medical Officer (Attending Surgeon), Division of Otorhinolaryngology, Head and Neck Surgeon, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Robert Leonard
authors.initials: RL
authors.lastname: Eisenberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000556:secondary / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000601:surgery*; D017233:Orbit Evisceration / Q000379:methods*; D009918:Orbital Neoplasms / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome