Impact of microscopic orbital periosteum invasion in orbital preservation surgery.
Impact of microscopic orbital periosteum invasion in orbital preservation surgery.
复制标题
显微眼眶骨膜侵入对眼眶保留手术的影响。
DOI：
10.1093/jjco/hyw207
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Yoshimoto S.
中科院分区：
文献类型：
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作者：
Kobayashi K;Mori T;Matsumoto F;Murakami N;Teshima M;Fukasawa M;Matsumoto Y;Matsumura S;Itami J;Asai M;Yoshimoto S.
眼眶骨膜被认为是肿瘤扩散的屏障;然而，在手术过程中很难评估显微镜下的肿瘤扩散。本研究旨在评估病理状态在眼眶保留手术中的影响。MethodsWe回顾性分析了2006年至2012年间接受治疗的恶性肿瘤侵犯眼眶患者的3年局部控制率和治疗结果。病理学上，19例为癌，8例为肉瘤。其中眼眶内容物摘除术6例，保留眼眶手术21例。眼眶保留手术后3年局部控制率较差与手术切缘阳性（阴性与阳性：91%vs.41%，P = 0.040）和显微镜下眼眶骨膜侵犯（阴性与阳性：90%vs.39%，P = 0.010）显著相关。在多因素分析中，这些因素是独立的危险因素。阳性边缘多见于眶骨膜水平缘、垂直缘及眶尖后缘。此外，在24%的患者中，术前影像学检查的浸润评估被低估，与术后显微镜evaluation.ConclusionsThe积极的手术切缘和显微镜下眶骨膜侵犯眼眶复发的危险因素。由于术前准确的病理状态难以预测以及术前影像学评估的局限性，术前影像学检查难以确定眼眶保留手术的适应证。
ObjectiveThe orbital periosteum is considered to be a barrier to tumor spread; however, it is difficult to evaluate microscopic tumor spread during surgery. This study aimed to assess the impact of pathological status in orbital preservation surgery.MethodsWe retrospectively analyzed the 3-year local control rate and treatment outcomes of patients with malignant tumors invading the orbit who were treated between 2006 and 2012.ResultsIn total, 27 patients were reviewed over a median follow-up period of 36 months. Pathologically, 19 had carcinomas and 8 had sarcomas. Treatment was by orbital exenteration in 6 patients and orbital preservation surgery in 21 patients. After orbital preservation surgery, poorer 3-year local control rates were significantly associated with positive surgical margins (negative vs. positive: 91% vs. 41%,P= 0.040) and microscopic orbital periosteum invasion (negative vs. positive: 90% vs. 39%,P= 0.010). These factors were independent risk factors in multivariate analysis. The locations of the positive margin were most common at the horizontal and vertical margins of the orbital periosteum and the posterior margin of the orbital apex. Moreover, in 24% of patients, invasion evaluation by preoperative imaging study was underestimated compared with postoperative microscopic evaluation.ConclusionsThe positive surgical margin and microscopic orbital periosteum invasion were the risk factors of orbital recurrence. It is difficult to determine the indications for orbital preservation surgery by preoperative imaging studies because of the unpredictable accurate pathological status before surgery and the limitations of preoperative imaging evaluation.