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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.
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.
摘要：
背景：颅面病变（CFL）患者的眼眶切除术（OE）的结果尚不清楚。本综述总结了关于OE临床结局的现有文献，包括手术结果和总生存期（OS）。
方法：相关文章检索自Medline,Scopus,和Cochrane根据PRISMA指南。对其临床特征进行了系统评价和荟萃分析，管理,和结果。
结果：共纳入33篇文章，包含957例因CFL而接受OE的患者（加权平均年龄：64.3岁[95%CI：59.9-68.7]；58.3%为男性）。最常见的病变是鳞状细胞癌(31.8%),最常见的症状是视力障碍/视力下降(22.5%)。在患者中，302（31.6%）总OE，248（26.0%）延长了OE，87例(9.0%)患有小计OE。游离皮瓣(33.3%),骨内植入物（22.8%），最常用的重建方法是分裂厚度的皮肤移植物（17.2％）。鼻甲眶或鼻甲瘘(22.6%),皮瓣或移植物失败（16.9%），和骨肥大（13％）是最多的报告并发症。关于肿瘤复发，当地的38.6%，32.3％的人很遥远，区域占6.7%。神经周浸润率为17.4%,而淋巴管浸润率为5.0%。在23.6个月的加权平均随访期内（95%CI：13.8-33.4），加权总死亡率为39%(95%CI:28-50%).5年OS率为50%（中位数：61个月[95%CI：46-83]）。OS多变量分析未显示任何显著发现。
结论：尽管OE是一种具有破坏性结果的毁容程序，对于精心挑选的晚期CFL患者,这是一个可行的选择.基于肿瘤病理的患者量身定制的方法，扩展,和整体患者的情况是必要的。
方法：相关文章检索自Medline,Scopus,和Cochrane根据PRISMA指南。对其临床特征进行了系统评价和荟萃分析，管理,和结果。
结果：共纳入33篇文章，包含957例因CFL而接受OE的患者（加权平均年龄：64.3岁[95%CI：59.9-68.7]；58.3%为男性）。最常见的病变是鳞状细胞癌(31.8%),最常见的症状是视力障碍/视力下降(22.5%)。在患者中，302（31.6%）总OE，248（26.0%）延长了OE，87例(9.0%)患有小计OE。游离皮瓣(33.3%),骨内植入物（22.8%），最常用的重建方法是分裂厚度的皮肤移植物（17.2％）。鼻甲眶或鼻甲瘘(22.6%),皮瓣或移植物失败（16.9%），和骨肥大（13％）是最多的报告并发症。关于肿瘤复发，当地的38.6%，32.3％的人很遥远，区域占6.7%。神经周浸润率为17.4%,而淋巴管浸润率为5.0%。在23.6个月的加权平均随访期内（95%CI：13.8-33.4），加权总死亡率为39%(95%CI:28-50%).5年OS率为50%（中位数：61个月[95%CI：46-83]）。OS多变量分析未显示任何显著发现。
结论：尽管OE是一种具有破坏性结果的毁容程序，对于精心挑选的晚期CFL患者,这是一个可行的选择.基于肿瘤病理的患者量身定制的方法，扩展,和整体患者的情况是必要的。
