This study investigated the description and feasibility of a surgical procedure for enucleation-exenteration of the equine eye via the supraorbital fossa. A preliminary study was performed on both eyes of four cadaveric heads of native breed donkeys (Equus asinus) to describe the surgical anatomy and demonstrate a new supraorbital enucleation surgical approach. For the clinical study, eight donkeys were admitted for unilateral enucleation. All procedures were performed in a lateral recumbent position under the influence of inhalation anesthesia in combination with a retrobulbar nerve block. A semi-circular incision was made in the skin and fascia of the supraorbital fossa to gain access into the orbital cavity, after which the periorbital fat was dissected and removed. Bleeding was controlled by electrocautery and large blood vessels were ligated, then the eyeball was dissected sharply and freed from its bony attachment. The procedure was successfully accomplished in all clinical cases, and no significant complications occurred during or throughout the postoperative follow-up period. The initial results suggest the feasibility and safety of the supraorbital enucleation technique described in this study for equine eye enucleation. This new technique seems promising due to its feasibility, safety, and positive outcomes observed in both cadaveric and clinical studies.

BACKGROUND: The study aimed to describe clinical indications for eye enucleation and exenteration, the occurrence of complications and long-term outcome in cattle, and examine owners\' attitude towards enucleation and exenteration and their satisfaction with the surgical outcome. Medical records from the two veterinary teaching hospitals in Switzerland were reviewed to identify cattle that underwent unilateral enucleation or exenteration between January 2013 and December 2020. Data extracted included medical history, ocular examination, clinical diagnosis, surgical procedure including anesthesia, suture material and pattern used, complications, and treatment thereof. Long-term follow-up was evaluated via national animal database inquiries to determine survival time and via owners\' interviews with the use of a standardized questionnaire that included questions regarding the occurrence of complications and reason for culling, production performances and perceived quality of life after surgery, concerns, factors affecting the decision to proceed with surgery, and general satisfaction with the outcome. Descriptive statistics, Fisher\'s exact tests and unpaired t-test were used to summarize the data and assess association between variables. Association was considered significant if p < 0,05. Thirty-eight cases were identified, with a median age of 5 years. More than half of the cases (55,3 %) were diagnosed with non-neoplastic ocular lesions represented by severe trauma with loss of globe content, globe rupture with history of infectious keratoconjunctivitis or hypopyon, or congenital malformations. The remaining cases were diagnosed with neoplastic lesions, including ocular squamous cell carcinoma (OSCC), melanoma, or sarcoma. Complications following surgery were reported in 29 % of cases and included postoperative infection and recurrence of OSCC. There was no significant association between ocular diagnosis and the occurrence of postoperative complications or survival time. Surgery did not seem to influence the animals\' postoperative production performance or the perceived quality of life. Most owners (92 %) were satisfied with the surgical outcome. The occurrence of postoperative complications leading to increased overall costs and culling was the main reason for lower owner satisfaction.
BACKGROUND: Ziel der Studie war es, die klinischen Indikationen für die Enukleation und Exenteration des Augapfels, das Auftreten von Komplikationen und das Langzeitergebnis beim Rind zu beschreiben. Zusätzlich wurde die Einstellung der Besitzer zur Enukleation und Exenteration sowie ihre Zufriedenheit mit dem chirurgischen Ergebnis untersucht. Die Krankenakten der beiden veterinärmedizinischen Lehrspitäler in der Schweiz wurden überprüft, um Rinder zu identifizieren, die zwischen Januar 2013 und Dezember 2020 einer einseitigen Enukleation oder Exenteration unterzogen wurden. Die extrahierten Daten umfassten Anamnese, Augenuntersuchung, klinische Diagnose, chirurgischer Eingriff einschliesslich Anästhesie, verwendetes Nahtmaterial und – technik, Komplikationen und deren Behandlung. Zur Bestimmung der Langzeitbehandlungsergebnisse wurde die Überlebenszeit der Tiere mittels Abfragen in der nationalen Tierdatenbanken bestimmt und Besitzerinterviews unter Verwendung eines standardisierten Fragebogens durchgeführt. Abgefragt wurde das Auftreten von Komplikationen, Gründe für das Keulen, Produktionsleistung, wahrgenommene Lebensqualität nach dem Eingriff, Bedenken, Entscheidungsfaktoren die Operation durchzuführen, und allgemeine Zufriedenheit mit dem Ergebnis. Die Daten wurden mittels deskriptiver Statistik zusammengefasst und mögliche Unterschiede zwischen den Variablen mittels Exaktem Fisher-Tests und ungepaarten t-Test analysiert. Das Signifikanzniveau wurde bei p < 0,05 festgelegt. Die Studie umfasste 38 Fälle mit einem Durchschnittsalter von 5 Jahren. Mehr als die Hälfte der Fälle (55,3 %) wurden mit nicht-neoplastischen Augenläsionen diagnostiziert, die durch ein schweres Trauma mit Verlust des Bulbusinhaltes, Bulbusruptur mit Vorgeschichte einer infektiösen Keratokonjunktivitis, Hypopyon oder angeborene Fehlbildungen gekennzeichnet waren. Bei den verbleibenden Fällen wurden neoplastische Läsionen diagnostiziert, darunter okulares Plattenepithelkarzinom (OSCC), Melanom oder Sarkom. Postoperative Komplikationen wurden in 29 % der Fälle berichtet und umfassten Infektionen und Rezidive von OSCC. Es gab keine signifikanten Zusammenhänge zwischen der Diagnose und dem Auftreten postoperativer Komplikationen oder der Überlebenszeit. Die Operation schien die postoperative Produktionsleistung der Tiere oder die wahrgenommene Lebensqualität nicht zu beeinflussen. Die meisten Besitzer (92 %) waren mit dem Ergebnis zufrieden. Das Auftreten von postoperativen Komplikationen, die zu erhöhten Gesamtkosten und Keulungen führten, war der Hauptgrund für die geringere Zufriedenheit der Tierhalter.
BACKGROUND: La présente étude vise à décrire les indications cliniques de l’énucléation et de l’exentération de l’œil, la survenue de complications et le résultat à long terme chez les bovins et à examiner l’attitude des propriétaires vis-à-vis de l’énucléation et de l’exentération et leur satisfaction quant au résultat chirurgical. Les dossiers médicaux des deux hôpitaux universitaires vétérinaires de Suisse ont été examinés pour identifier les bovins qui ont subi une énucléation ou une exentération unilatérale entre janvier 2013 et décembre 2020. Les données extraites comprenaient les antécédents médicaux, l’examen oculaire, le diagnostic clinique, la procédure chirurgicale y compris l’anesthésie, le matériel et le patron de suture utilisés, les complications et leur traitement. Le suivi à long terme a été évalué en utilisant la base de données nationale sur les animaux afin de déterminer la durée de survie, et par d’entretiens avec les propriétaires à l’aide d\'un questionnaire standardisé qui comprenait des questions concernant l’apparition de complications et la raison de la réforme, les performances de production et la qualité de vie perçue après la chirurgie, les réserves, les facteurs affectant la décision de procéder à la chirurgie et la satisfaction générale du résultat. Les données ont été résumées à l’aide de statistiques descriptives et les différences éventuelles entre les variables ont été analysées à l’aide de tests exacts de Fisher et de tests t non appariés. L’association a été considérée comme significative si p < 0,05. Trente-huit cas ont été identifiés, avec un âge médian de 5 ans. Plus de la moitié des cas (55,3 %) ont été diagnostiqués avec des lésions oculaires non néoplasiques causées par un traumatisme grave avec perte du contenu du globe, une rupture du globe avec des antécédents de kératoconjonctivite infectieuse ou d’hypopion ou des malformations congénitales. Les autres cas ont été diagnostiqués comme des lésions néoplasiques, notamment carcinome épidermoïde oculaire, mélanome ou sarcome. Des complications après l’opération ont été signalées dans 29 % des cas, notamment infection postopératoire et récidive du carcinome épidermoïde oculaire. Il n’y avait pas d’association significative entre le diagnostic et l’apparition de complications postopératoires ou la durée de survie. L’intervention chirurgicale n’a pas semblé influencer les performances de production postopératoires des animaux ni la qualité de vie perçue. La plupart des propriétaires (92 %) étaient satisfaits du résultat de la chirurgie. L’apparition de complications postopératoires entraînant une augmentation des coûts globaux et l’abattage des animaux était la principale raison de la baisse de satisfaction des propriétaires.
BACKGROUND: Lo studio si proponeva di descrivere le indicazioni cliniche per l’enucleazione e l’esenterazione del bulbo oculare, l’insorgenza di complicazioni e l’esito a lungo termine nei bovini, nonché di esaminare l’atteggiamento dei proprietari nei confronti dell’enucleazione e dell’esenterazione e la loro soddisfazione per l’esito dell’intervento. Le cartelle cliniche dei due ospedali veterinari in Svizzera sono state esaminate per identificare i bovini sottoposti a enucleazione o esenterazione unilaterale tra gennaio 2013 e dicembre 2020. I dati estratti comprendevano l’anamnesi, l’esame oculare, la diagnosi clinica, la procedura chirurgica, compresa l’anestesia, il materiale di sutura e la tecnica utilizzata, le complicazioni e il relativo trattamento. Il follow-up a lungo termine è stato valutato tramite indagini sul database nazionale degli animali per determinare il tempo di sopravvivenza e tramite interviste ai proprietari con l’uso di un questionario standardizzato che includeva domande riguardanti l\'insorgenza di complicazioni e il motivo della macellazione, le prestazioni produttive e la qualità di vita percepita dopo l’intervento, le inquietudini, i fattori che hanno influenzato la decisione di procedere con l’intervento e la soddisfazione generale per il risultato. I dati sono stati sintetizzati utilizzando le statistiche descrittive e le eventuali differenze tra le variabili sono state analizzate utilizzando il test esatto di Fisher e il t-test non accoppiato. L’associazione è stata considerata significativa se il valore di p < 0,05. Sono stati identificati 38 casi, con un’età media di 5 anni. In più della metà dei casi (55,3%) sono state diagnosticate lesioni oculari non neoplastiche, rappresentate da gravi traumi con perdita del contenuto del globo, rottura del globo con anamnesi di cheratocongiuntivite infettiva o ipopion, o malformazioni congenite. Nei restanti casi sono state diagnosticate lesioni neoplastiche, tra cui carcinoma oculare spinocellulare (OSCC), melanoma o sarcoma. Le complicazioni successive all’intervento chirurgico sono state riportate nel 29% dei casi e comprendevano infezioni postoperatorie e recidive di OSCC. Non è stata riscontrata alcuna associazione significativa tra la diagnosi oculare e la comparsa di complicazioni postoperatorie o il tempo di sopravvivenza. L’intervento chirurgico non sembrava influenzare le prestazioni produttive degli animali dopo l’intervento o la qualità di vita percepita. La maggior parte dei proprietari (92%) era soddisfatta dell’esito dell’intervento. L’insorgenza di complicazioni post-operatorie che hanno comportato un aumento dei costi complessivi e la macellazione è stata la ragione principale della minore soddisfazione dei proprietari.

To report the therapeutic efficacy of integrating neoadjuvant chemotherapy with conventional bimodal therapies for lacrimal gland adenoid cystic carcinoma by providing an additional 8 years of follow-up data on the same cohort of patients whose cumulative 10-year disease-free survival outcomes were reported in 2013.
Non-randomized, retrospective, interventional case series.
Nineteen consecutive patients treated with neoadjuvant intra-arterial cytoreductive chemotherapy (IACC), orbital exenteration, chemoradiotherapy, and adjuvant intravenous chemotherapy at a single institution were included. Analyses were undertaken of locoregional recurrences and distant metastases, disease-free survival time, TNM tumor stage at presentation, response to IACC, and prognostic impact of positive resection margins. The main outcome measures were overall survival, disease-free survival, disease relapse, positive tumor resection margins, and tumor stage at presentation.
Eight patients with an intact lacrimal artery (group 1), 7 with AJCC stage T4a-c, had significantly better overall survival (87.5% versus 14.3% at 15 years), disease-specific mortality, and recurrences (all < .001, log-rank test) than prior conventionally treated patients from the Bascom Palmer Eye Institute. Group 1 was superior to group 2, patients lacking an intact lacrimal artery, concerning overall survival (P = .042) and recurrence (P = .017), but with no significant difference in disease-specific mortality (P = .23). Group 2 was associated with a significantly lower cause-specific mortality than the institutional comparator group (P = .039). Prior tumor resection with lateral wall osteotomy and failure to adhere to all protocol elements were adverse prognostic factors for suboptimal outcomes. Positive tumor margins increased the risk of all-cause mortality 4.1 times (P = .036, stratified Cox proportional hazards regression) and disease-specific mortality 8.0 times (P = .043, stratified Cox proportional hazards regression) than a patient with negative margins.
Extended follow-up supplemented with AJCC staging data supports neoadjuvant IACC as an integral component of a trimodal treatment strategy in patients with an intact lacrimal artery. Protocol elements implemented as designed appear to have improved overall survival and decreased disease relapse in this cohort. This extended long-term IACC dataset suggests that a critical bar of at least 15 years of follow-up is appropriate for assessing the efficacy of current conventional and future globe-sparing bimodal therapies.

BACKGROUND: The treatment of conjunctival melanoma is most often conservative, but exenteration is sometimes necessary in order to achieve local control of the disease. It can be performed as a primary procedure in cases of locally advanced disease or as a secondary procedure after one or more recurrences. No benefit to secondary exenteration on patient survival has been demonstrated to date for conjunctival melanoma, and it is generally considered a palliative procedure.
METHODS: Single-center retrospective study performed in the ocular oncology department of the Institut Curie (Paris, France). We included all patients who underwent secondary orbital exenteration for conjunctival melanoma between January 2008 and January 2016.
RESULTS: Twenty-five patients underwent secondary exenteration for conjunctival melanoma. The maximum number of local recurrences prior to exenteration was six. Metastases occurred in 11 patients after exenteration and were more common when there was a greater tumor thickness on histology, if the tumor had not been treated initially in an ocular oncology center, or if there had been a greater number of local recurrences before the secondary exenteration was performed. Seventy-five percent of patients developed metastases when the exenteration was performed after 5 or 6 local recurrences.
CONCLUSIONS: This study suggests that early secondary exenteration (i.e. after a number of local recurrences less than or equal to 4) may reduce the occurrence of metastases (and therefore improve patient survival) in conjunctival melanoma. Thus, secondary exenteration might be a curative surgery in some patients with recurrent disease.

Optimization of preoperative nutritional status has been recommended and associated with improved outcomes for other oncologic procedures, but has not been studied in patients undergoing pelvic exenteration.
A retrospective chart review of 199 patients was conducted. Overall survival (OS) was calculated using the Kaplan-Meier method and multivariate analysis was performed with Cox proportional hazards.
199 patients underwent PE with 61 (31%), 78 (40%) and 58 (29%) patients having colorectal, gynecologic and urologic histological diagnoses, respectively. Median OS following PE was 25 months. Preoperative serum albumin <3.5 g/dL was associated with worsened OS (HR 1.661; 95% CI 1.052-2.624) as well as increased incidence of any postoperative complication (85.9% vs 72.3%, p = 0.034), but was not associated with 90-day mortality (11.3% vs 7.9%, p = 0.457).
Poor preoperative nutritional status is associated with increased complications and decreased OS. Surgeons should maximize preoperative nutritional status to improve perioperative outcomes and long-term survival.

OBJECTIVE: To describe the indications for exenteration and complications associated with the procedure.
METHODS: 115 cattle.
METHODS: Medical records of cattle presented for unilateral exenteration evaluated at the University of California, Davis Veterinary Medical Teaching Hospital from January 1985 through December 2015 were reviewed.
RESULTS: Median (range) age at presentation for all cattle was 6 (0.2-30) years. The most prevalent (80.9%) indication for exenteration was squamous cell carcinoma (SCC). Cattle >5 years had higher odds (OR = 11.2, 95% CI, 2.8-45.8) for undergoing exenteration due to SCC compared to cattle ≤5 years. Herefords had higher odds (OR = 4.6, 95% CI, 1.5-14.6) for undergoing exenteration for SCC compared to other breeds. Holsteins had higher odds (OR = 140.7, 95% CI, 7.5-2644) for undergoing exenteration for retrobulbar lymphoma compared to other breeds. Complications following exenteration were reported in 15 cases (13.0%). The postsurgical complications were orbital abscesses (6/15), recurrence of SCC (5/15), wound dehiscence (3/15), and excessive hemorrhage (1/15). Median (range) time to occurrence of postsurgical complications was 19 (5-205) days. There was no significant association (P > 0.05) between ocular diagnosis, age, anesthetic technique or the suture pattern used to close the skin postsurgically, and occurrence of postsurgical complications.
CONCLUSIONS: Early clinical diagnosis of SCC by owners and veterinarians may prevent the need for exenteration. Owners should be made aware of the possible postsurgical complications following exenteration in cattle.

OBJECTIVE: To determine overall survival (OS) and factors associated with OS after pelvic exenteration for uterine cancer.
METHODS: Women with uterine cancer who underwent exenteration (n=1160) were identified from the 1998-2011 National Cancer Data Base. Kaplan-Meier and multivariate Cox proportional-hazards survival analyses were performed to test for associations of potential explanatory variables with OS. Analyzed confounders included age, comorbidity score, insurance status, income, distance from home to treatment center, stage, distant and nodal metastasis, tumor size, surgical margin status, exenteration type, and treatment with radiation and/or chemotherapy.
RESULTS: Among women with follow-up data (n=652), median (IQR) OS was 63.1 (42.2-107.2) and 17.6 (14.7-23.9) months for women with node-negative versus node-positive disease, respectively. Histology (p=1.5×10-4), grade (p=7.9×10-14), race (p=0.0002), lymph node status (p=1.0×10-14), surgical node evaluation (p=2.8×10-8), surgery for distant metastasis (p=0.004), distant metastasis at diagnosis (p=1.3×10-10), positive surgical margins (p=1.6×10-9), radiotherapy (p=0.004), and insurance status (p=6.5×10-6) were significantly associated with differential, unadjusted Kaplan-Meier OS estimates. Exenteration type was not associated with OS (p=0.357). By multivariate regression, increased age, positive surgical margins, nodal metastasis or unknown nodal status, higher histologic grade, and black race were associated with increased hazards for death.
CONCLUSIONS: Exenteration may be curative for well-selected women with uterine cancer, particularly among women with pathologically negative lymph nodes.