Orbital exenteration for craniofacial lesions: A systematic review and meta-analysis of patient characteristics and survival outcomes Review


Authors: Qedair, J.; Haider, A. S.; Balasubramanian, K.; Palmisciano, P.; Hassan, T.; Shahbandi, A.; Sabahi, M.; Kharbat, A. F.; Abou-Al-Shaar, H.; Yu, K.; Cohen-Gadol, A. A.; El Ahmadieh, T. Y.; Bin-Alamer, O.
Review Title: Orbital exenteration for craniofacial lesions: A systematic review and meta-analysis of patient characteristics and survival outcomes
Abstract: Background: The outcomes of orbital exenteration (OE) in patients with craniofacial lesions (CFLs) remain unclear. The present review summarizes the available literature on the clinical outcomes of OE, including surgical outcomes and overall survival (OS). Methods: Relevant articles were retrieved from Medline, Scopus, and Cochrane according to PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management, and outcomes. Results: A total of 33 articles containing 957 patients who underwent OE for CFLs were included (weighted mean age: 64.3 years [95% CI: 59.9–68.7]; 58.3% were male). The most common lesion was squamous cell carcinoma (31.8%), and the most common symptom was disturbed vision/reduced visual acuity (22.5%). Of the patients, 302 (31.6%) had total OE, 248 (26.0%) had extended OE, and 87 (9.0%) had subtotal OE. Free flaps (33.3%), endosseous implants (22.8%), and split-thickness skin grafts (17.2%) were the most used reconstructive methods. Sino-orbital or sino-nasal fistula (22.6%), flap or graft failure (16.9%), and hyperostosis (13%) were the most reported complications. Regarding tumor recurrences, 38.6% were local, 32.3% were distant, and 6.7% were regional. The perineural invasion rate was 17.4%, while the lymphovascular invasion rate was 5.0%. Over a weighted mean follow-up period of 23.6 months (95% CI: 13.8–33.4), a weighted overall mortality rate of 39% (95% CI: 28–50%) was observed. The 5-year OS rate was 50% (median: 61 months [95% CI: 46–83]). The OS multivariable analysis did not show any significant findings. Conclusions: Although OE is a disfiguring procedure with devastating outcomes, it is a viable option for carefully selected patients with advanced CFLs. A patient-tailored approach based on tumor pathology, extension, and overall patient condition is warranted. © 2023 by the authors.
Keywords: survival; survival rate; overall survival; review; perforator flap; squamous cell carcinoma; outcome assessment; lymph node dissection; quality control; basal cell carcinoma; bone lesion; graft failure; systematic review; tumor recurrence; carcinoma; craniotomy; adenoid cystic carcinoma; outcomes; maxilla resection; meta analysis; sebaceous carcinoma; meta-analysis; eye pain; visual acuity; craniofacial; mortality rate; reconstructive surgery; lymph vessel metastasis; ethmoidectomy; human; orbital exenteration; bulbar conjunctiva; craniofacial lesion; hyperostosis; low vision
Journal Title: Cancers
Volume: 15
Issue: 17
ISSN: 2072-6694
Publisher: MDPI  
Date Published: 2023-09-01
Start Page: 4285
Language: English
DOI: 10.3390/cancers15174285
PROVIDER: scopus
PMCID: PMC10487227
PUBMED: 37686561
DOI/URL:
Notes: Review -- Source: Scopus
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  1. Kenny Kwok Hei Yu
    32 Yu