The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform

Michael J Solomon - One of the best experts on this subject based on the ideXlab platform.

  • Outcomes following repeat Exenteration for locally advanced pelvic malignancy.
    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2020
    Co-Authors: Joshua Blake, Kilian G M Brown, Kirk K S Austin, Cherry E. Koh, Daniel Steffens, Marie Shella De Robles, Peter J. Lee, Michael J Solomon
    Abstract:

    AIM This study aims to assess surgical outcomes and survival following first, second and third pelvic Exenterations for pelvic malignancy. METHOD Consecutive patients undergoing pelvic Exenteration for pelvic malignancy at a quaternary referral centre from January 1994 and December 2017 were included. Demographics and surgical outcomes were compared between patients who underwent first, second and third pelvic Exenterations by generalized mixed modelling with repeated measures. Survival was assessed using Cox proportional hazards models and Kaplan-Meier plots. RESULTS Of the 642 Exenterations reviewed, 29 (4.5%) were second and 6 (0.9%) were third Exenterations. Patients selected for repeat Exenteration were more likely to have asymptomatic local recurrences detected on routine surveillance (P 

  • a qualitative study of the development of a multidisciplinary case conference review methodology to reduce involved margins in pelvic Exenteration surgery for recurrent rectal cancer
    Colorectal Disease, 2018
    Co-Authors: G H Van Ramshorst, Sarah Oshannassy, Wendy Brown, James G Kench, Michael J Solomon
    Abstract:

    Aim: Pelvic Exenteration surgery remains the only curative option for recurrent rectal cancer. Microscopically involved surgical margins (R1) are associated with a higher risk of local recurrence and decreased survival. Our study aimed to develop a post hoc multidisciplinary case conference review and investigate its potential for identifying areas for improvement. Method: Patients who underwent pelvic Exenteration surgery for recurrent rectal cancer with R1 resections at a tertiary referral centre between April 2014 and January 2016 were retrospectively reviewed from a prospectively maintained database. Patients with non-rectal cancers or who underwent palliative surgery were excluded. Cases, imaging and histopathology were evaluated by a dedicated panel including colorectal surgeons, an abdominal radiologist and a gastrointestinal pathologist. Results: R1 resections were reported in 32 of 110 pelvic Exenterations. Patients with other tumours were excluded and one patient had a palliative resection. Nine male patients with 11 Exenterations were included with a median age of 56 years. All patients had positive soft tissue margins, and one patient also had an involved bony margin. Failures were due to (interdisciplinary) communication problems, specific management of tumour biology (multifocality, spiculated tumours), which can lead to radiological undercalling, and inadequate surgical technical planning. In hindsight, surgery would have been withheld from one patient. Conclusion: A retrospective multidisciplinary case evaluation of pelvic Exenteration patients with involved surgical margins led to a list of recommendations which included the need to plan for wider surgical soft tissue resections and improvement in interdisciplinary communication. Lessons learned may increase clear margin rates in future resections.

  • The Price We Pay for Radical Curative Pelvic Exenterations: Prevalence and Management of Pain.
    Diseases of The Colon & Rectum, 2018
    Co-Authors: Michael J Solomon, Charlotte S.h. Johnstone
    Abstract:

    BACKGROUND: Pelvic Exenterations are extensive surgical procedures for locally advanced or recurrent malignancies of the pelvis. However, this is often at the cost of significant morbidity due to perioperative pain, which has been poorly studied. OBJECTIVE: This study aims to review perioperative pain management in patients undergoing pelvic Exenteration. DESIGN: This is a retrospective review of patients undergoing pelvic Exenteration between January 2013 and December 2014. Data were gathered from medical records and a prospectively maintained database. SETTING: This study was conducted at a single quaternary referral center for pelvic Exenteration. PATIENTS: Consecutive patients underwent pelvic Exenteration at a single center. INTERVENTIONS: Pelvic Exenteration was performed in consecutive patients. MAIN OUTCOMES MEASURES: Primary outcomes were the prevalence of preoperative pain, preoperative opiate use (type, dosage), and postoperative pain (verbal numerical rating scale). Secondary outcomes included the number of pain consultations and correlations between preoperative opiate use, length of stay, and extent of resection (en bloc sacrectomy and nerve excision). RESULTS: Ninety-nine patients underwent pelvic Exenteration. Sixty-one patients (61.6%) underwent major nerve resection and/or sacrectomy. Thirty patients (30%) required opiates preoperatively, with a mean daily morphine equivalent of 72.9 mg (SD 65.0 mg). Patients on preoperative opiates were more likely to have worse pain postoperatively and to require higher opiate doses and more pain consultations (9.3 vs 4.8; p < 0.001). Major nerve excision and sacrectomy were not associated with worse postoperative pain. By discharge, 60% still required opiate analgesia. LIMITATIONS: Retrospective study design, the subjective nature of pain assessment because of a lack of valid methods to objectively quantify pain, and the lack of long-term follow-up were limitations of this study. CONCLUSIONS: Perioperative pain is a significant issue among patients undergoing pelvic Exenteration. One in three patients require high-dose opiates preoperatively that is associated with worse pain outcomes. Potential areas to improve pain outcomes in these complex patients could include increased use of regional anesthesia, antineuropathic agents, and opiate-sparing techniques. See Video Abstract at http://links.lww.com/DCR/A572.

  • outcomes of pelvic Exenteration for locally advanced primary rectal cancer overall survival and quality of life
    Ejso, 2016
    Co-Authors: A J Quyn, Tim Badgeryparker, Rachael Roberts, Kirk K S Austin, Lindy Masya, Jane M Young, Michael J Solomon
    Abstract:

    Abstract Introduction Radical surgery with pelvic Exenteration offers the only potential for cure in patients with locally advanced primary rectal cancer. This study describes the clinical and patient-reported quality of life outcomes over 12 months for patients having pelvic Exenteration for locally advanced primary rectal cancer at a specialised centre for pelvic Exenteration. Methods Clinical data of consecutive patients undergoing pelvic Exenteration for locally advanced primary rectal cancer and patient-reported outcomes were collected at baseline, hospital discharge and at 1, 3, 6, 9 and 12 months. Patient-reported outcomes included cancer-specific quality of life (QoL) and physical and mental health status. Quality of life trajectories were modelled over the 12 months from the date of surgery using linear mixed models. Results 104 patients with locally advanced rectal cancer underwent pelvic Exenteration at Royal Prince Alfred Hospital, Sydney, between December 1994 and October 2014. Complete soft tissue Exenteration was performed in 38%. A clear margin was obtained in 86% with a 62% overall five-year survival. QoL outcome questionnaires were completed by 62% of patient cohort. The average FACT-C score returned to pre-surgery QoL by 2 months after surgery, and the average QoL continued to increase slowly over the 12 months. Conclusion Our results support an aggressive approach to advanced primary rectal cancer and lend weight to the oncological role of pelvic Exenteration for this group of patients. Quality of life improves rapidly after pelvic Exenteration for locally advanced primary rectal cancer and continues to improve over the first year.

  • lateral pelvic compartment excision during pelvic Exenteration
    British Journal of Surgery, 2015
    Co-Authors: Michael J Solomon, Kilian G M Brown, Kirk K S Austin, Lindy Masya
    Abstract:

    Background Involvement of the lateral compartment remains a relative or absolute contraindication to pelvic Exenteration in most units. Initial experience with Exenteration in the authors' unit produced a 21 per cent clear margin rate (R0), which improved to 53 per cent by adopting a novel technique for en bloc resection of the iliac vessels and other side-wall structures. The objective of this study was to report morbidity and oncological outcomes in consecutive Exenterations involving the lateral compartment. Methods Patients undergoing pelvic Exenteration between 1994 and 2014 were eligible for review. Results Two hundred consecutive patients who had en bloc resection of the lateral compartment were included. R0 resection was achieved in 66·5 per cent of 197 patients undergoing surgery for cancer and 68·9 per cent of planned curative resections. For patients with colorectal cancer, a clear resection margin was associated with a significant overall survival benefit (P = 0·030). Median overall and disease-free survival in this group was 41 and 27 months respectively. Overall 1-, 3- and 5-year survival rates were 86, 46 and 35 per cent respectively. No predictors of survival were identified on univariable analysis other than margin status and operative intent. Excision of the common or external iliac vessels or sciatic nerve did not confer a survival disadvantage. Conclusion The continuing evolution of radical pelvic Exenteration techniques has seen an improvement in R0 margin status from 21 to 66·5 per cent over a 20-year interval by routine adoption of a more lateral anatomical plane. Five-year overall survival rates are comparable with those for more centrally based tumours.

Dinesh Selva - One of the best experts on this subject based on the ideXlab platform.

  • Cerebrospinal fluid leaks in orbital and lacrimal surgery
    Survey of Ophthalmology, 2008
    Co-Authors: Vanessa Limawararut, Alejandra A. Valenzuela, Nigel R. Jones, Raman Malhotra, Garry Davis, Timothy J. Sullivan, Alan A Mcnab, Dinesh Selva
    Abstract:

    Cerebrospinal fluid leakage is an uncommon but significant complication of orbital and rarely lacrimal surgery which may have serious consequences including death. In a retrospective review of four orbital units, we report an incidence of cerebrospinal fluid leak (diagnosed intraoperatively) during Exenteration, orbital decompression, and dacryocystorhinostomy of 1/154 (0.6%), 4/397 (1%), and 0/3,504 (0%), respectively. We found two additional cases of cerebrospinal fluid leaks associated with excision of orbital masses involving the orbital roof. In the literature, the incidence of cerebrospinal fluid leaks associated with orbital Exenterations and decompressions was 1.6-16.7% and 0-10%, respectively. Cerebrospinal fluid leaks occur very rarely in dacryocystorhinostomies with only a few case reports found in the literature. Preventative measures, diagnosis, and management of this complication are discussed. Knowledge of anatomy and thorough preoperative assessment may predict areas at high risk for encountering cerebrospinal fluid leaks. Proper surgical technique further minimizes the risk for this complication. If a cerebrospinal fluid leak occurs, however, prompt diagnosis and management usually results in uncomplicated recovery.

  • sino orbital fistula a complication of Exenteration
    Ophthalmology, 2007
    Co-Authors: Vanessa Limawararut, Garry Davis, Robert A. Goldberg, Igal Leibovitch, Guy Rees, Dinesh Selva
    Abstract:

    Purpose To report the incidence, characteristics, and management of sino-orbital fistulas, a complication of orbital Exenteration. Design Retrospective interventional case series. Participants One hundred ten patients who underwent orbital Exenteration at 2 orbital units. Methods Retrospective chart review of all cases of orbital Exenteration between 1993 and 2005 at one orbital unit and between 1999 and 2005 at a second orbital unit. Main Outcome Measures Incidence of sino-orbital fistulas. Results Seventy-three and 37 orbital Exenterations were performed at the first and second orbital units, respectively. Five patients developed sino-orbital fistulas, 1 of whom developed 2 fistulas at separate sites. In the first unit, 4 fistulas developed in 3 of 73 (4.1%) patients who underwent orbital Exenteration. In the second unit, 2 fistulas developed in 2 of 37 (5.4%) exenterated orbits. The majority (5/6) of fistulas occurred medially to the ethmoid sinus, whereas 1 occurred superiorly to the frontal sinus. Risk factors that may have contributed to fistula formation include radiotherapy (3/6), sinus disease (3/6), intraoperative penetration into a sinus (3/6), and immunocompromise (1/6). Management was tailored to the individual case and ranged from conservative socket hygiene to surgical repair with grafts or flaps. Four of the 6 fistulas recurred after repair. Three of these subsequently were closed successfully. Only 1 fistula persisted until the patient died from malignant disease. Conclusions Sino-orbital fistulas are uncommon but not rare complications of orbital Exenteration that may be predicted by several risk factors. Bothersome symptoms may necessitate treatment, which can range from conservative management to surgical repair with various grafts or flaps. Despite repair, fistulas may be difficult to eradicate.

Robert A. Goldberg - One of the best experts on this subject based on the ideXlab platform.

  • sino orbital fistula a complication of Exenteration
    Ophthalmology, 2007
    Co-Authors: Vanessa Limawararut, Garry Davis, Robert A. Goldberg, Igal Leibovitch, Guy Rees, Dinesh Selva
    Abstract:

    Purpose To report the incidence, characteristics, and management of sino-orbital fistulas, a complication of orbital Exenteration. Design Retrospective interventional case series. Participants One hundred ten patients who underwent orbital Exenteration at 2 orbital units. Methods Retrospective chart review of all cases of orbital Exenteration between 1993 and 2005 at one orbital unit and between 1999 and 2005 at a second orbital unit. Main Outcome Measures Incidence of sino-orbital fistulas. Results Seventy-three and 37 orbital Exenterations were performed at the first and second orbital units, respectively. Five patients developed sino-orbital fistulas, 1 of whom developed 2 fistulas at separate sites. In the first unit, 4 fistulas developed in 3 of 73 (4.1%) patients who underwent orbital Exenteration. In the second unit, 2 fistulas developed in 2 of 37 (5.4%) exenterated orbits. The majority (5/6) of fistulas occurred medially to the ethmoid sinus, whereas 1 occurred superiorly to the frontal sinus. Risk factors that may have contributed to fistula formation include radiotherapy (3/6), sinus disease (3/6), intraoperative penetration into a sinus (3/6), and immunocompromise (1/6). Management was tailored to the individual case and ranged from conservative socket hygiene to surgical repair with grafts or flaps. Four of the 6 fistulas recurred after repair. Three of these subsequently were closed successfully. Only 1 fistula persisted until the patient died from malignant disease. Conclusions Sino-orbital fistulas are uncommon but not rare complications of orbital Exenteration that may be predicted by several risk factors. Bothersome symptoms may necessitate treatment, which can range from conservative management to surgical repair with various grafts or flaps. Despite repair, fistulas may be difficult to eradicate.

  • Orbital Exenteration: one size does not fit all.
    American journal of ophthalmology, 2005
    Co-Authors: Guy J. Ben Simon, Robert M. Schwarcz, Raymond S. Douglas, Danica Fiaschetti, John D. Mccann, Robert A. Goldberg
    Abstract:

    Purpose To evaluate the clinical indications for orbital Exenteration in a tertiary referral center and to compare clinicopathologic correlation and cosmetic outcome with previously reported data. Design Retrospective, nonrandomized, consecutive case series. Methods Review of Electronic Medical Record system, Orbital Clinic, Jules Stein Eye Institute, between January 1999 and December 2003. main outcome measures: Surgery type, clear margins histologically, survival, and wearing an eye patch. Results Thirty-four patients (mean age 67 years) underwent orbital Exenteration; mean follow-up 1.2 ± 1.5 years (6 months to 6 years). Diagnosis included orbital, ocular, and adnexal malignancies, with squamous and basal cell carcinoma being the most common. Twenty-one patients (62%) underwent total or extended orbital Exenteration, and 13 patients (38%) underwent subtotal Exenteration including tissue reconstruction. Clear surgical margins were obtained in 23 cases (68%), whereas positive margins were left in 11 cases (32%). Many of the patients preferred an eye patch to cover the surgical region regardless of surgical reconstruction. Only 4 patients (11.8%) who underwent subtotal Exenteration with orbital prosthesis did not use a patch. During follow-up period 3 patients expired, only 1 of which was tumor-related. Conclusions Clinical indications for orbital Exenteration remain similar over the last four decades with a higher prevalence of squamous cell carcinoma in our institute. Orbital Exenteration is considered curative in cases of basal or squamous cell carcinoma but not in cases of malignant infiltrative processes such as adenoid cystic carcinoma of the lacrimal gland. Patients are likely to wear an eye patch regardless of any attempt at surgical reconstruction.

  • Orbital Exenteration: results of an individualized approach.
    Ophthalmic plastic and reconstructive surgery, 2003
    Co-Authors: Robert A. Goldberg, Jonathan W. Kim, Norman Shorr
    Abstract:

    Purpose The authors report and evaluate their experience with an individualized approach to orbital Exenteration. Methods Retrospective chart review was performed on a consecutive series of 25 orbital Exenteration patients at a tertiary care center. The cases were classified into two groups for the retrospective analysis: Total Exenteration procedures involved the removal of the entire orbital contents including the periorbita (13 cases), and subtotal procedures preserved at least a quadrant of the orbit or the orbital tissues posterior to the globe (12 cases). Results The total Exenteration group had a lower rate of clear surgical margins and a higher rate of systemic metastasis, whereas patients in the subtotal Exenteration group had fewer surgical complications and better functional and aesthetic results. Conclusions The surgical planning for orbital Exenteration should take into account the location, extent, and biological behavior of the orbital disease process and the reconstructive and prosthetic options for the exenterated socket. When an individualized approach to orbital Exenteration is used, subtotal procedures can offer improved functional and aesthetic results while still maximizing the chances for a surgical cure.

Vanessa Limawararut - One of the best experts on this subject based on the ideXlab platform.

  • Cerebrospinal fluid leaks in orbital and lacrimal surgery
    Survey of Ophthalmology, 2008
    Co-Authors: Vanessa Limawararut, Alejandra A. Valenzuela, Nigel R. Jones, Raman Malhotra, Garry Davis, Timothy J. Sullivan, Alan A Mcnab, Dinesh Selva
    Abstract:

    Cerebrospinal fluid leakage is an uncommon but significant complication of orbital and rarely lacrimal surgery which may have serious consequences including death. In a retrospective review of four orbital units, we report an incidence of cerebrospinal fluid leak (diagnosed intraoperatively) during Exenteration, orbital decompression, and dacryocystorhinostomy of 1/154 (0.6%), 4/397 (1%), and 0/3,504 (0%), respectively. We found two additional cases of cerebrospinal fluid leaks associated with excision of orbital masses involving the orbital roof. In the literature, the incidence of cerebrospinal fluid leaks associated with orbital Exenterations and decompressions was 1.6-16.7% and 0-10%, respectively. Cerebrospinal fluid leaks occur very rarely in dacryocystorhinostomies with only a few case reports found in the literature. Preventative measures, diagnosis, and management of this complication are discussed. Knowledge of anatomy and thorough preoperative assessment may predict areas at high risk for encountering cerebrospinal fluid leaks. Proper surgical technique further minimizes the risk for this complication. If a cerebrospinal fluid leak occurs, however, prompt diagnosis and management usually results in uncomplicated recovery.

  • sino orbital fistula a complication of Exenteration
    Ophthalmology, 2007
    Co-Authors: Vanessa Limawararut, Garry Davis, Robert A. Goldberg, Igal Leibovitch, Guy Rees, Dinesh Selva
    Abstract:

    Purpose To report the incidence, characteristics, and management of sino-orbital fistulas, a complication of orbital Exenteration. Design Retrospective interventional case series. Participants One hundred ten patients who underwent orbital Exenteration at 2 orbital units. Methods Retrospective chart review of all cases of orbital Exenteration between 1993 and 2005 at one orbital unit and between 1999 and 2005 at a second orbital unit. Main Outcome Measures Incidence of sino-orbital fistulas. Results Seventy-three and 37 orbital Exenterations were performed at the first and second orbital units, respectively. Five patients developed sino-orbital fistulas, 1 of whom developed 2 fistulas at separate sites. In the first unit, 4 fistulas developed in 3 of 73 (4.1%) patients who underwent orbital Exenteration. In the second unit, 2 fistulas developed in 2 of 37 (5.4%) exenterated orbits. The majority (5/6) of fistulas occurred medially to the ethmoid sinus, whereas 1 occurred superiorly to the frontal sinus. Risk factors that may have contributed to fistula formation include radiotherapy (3/6), sinus disease (3/6), intraoperative penetration into a sinus (3/6), and immunocompromise (1/6). Management was tailored to the individual case and ranged from conservative socket hygiene to surgical repair with grafts or flaps. Four of the 6 fistulas recurred after repair. Three of these subsequently were closed successfully. Only 1 fistula persisted until the patient died from malignant disease. Conclusions Sino-orbital fistulas are uncommon but not rare complications of orbital Exenteration that may be predicted by several risk factors. Bothersome symptoms may necessitate treatment, which can range from conservative management to surgical repair with various grafts or flaps. Despite repair, fistulas may be difficult to eradicate.

Norbert Pfeiffer - One of the best experts on this subject based on the ideXlab platform.

  • maggot therapy following orbital Exenteration
    British Journal of Ophthalmology, 2007
    Co-Authors: Adrian Gericke, Esther M Hoffmann, Susanne Pitz, Norbert Pfeiffer
    Abstract:

    Orbital Exenteration is a radical surgery reserved for the treatment of locally invasive or potentially life-threatening orbital tumours.1 Complications occur after 20–25% of Exenterations and include tissue necrosis (6%) and infection (3–4%).2–4 In the present report, we describe the management of a post-Exenteration orbital infection by the use of maggots. An 82-year-old multimorbid man presented with a fist-sized painless tumour of the left orbit (fig 1A). Computed tomography demonstrated an orbital mass clearly demarcated from the surrounding tissue (fig 1B). After biopsy, the neoplasm was classified as a borderline-malignant extrapleural solitary fibrous tumour. Therefore, a total orbital Exenteration was performed, and the wound was left open to …