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Abstract
BackgroundOrbital exenteration is a disfiguring procedure that aims to achieve local control. It is commonly a part of the management of malignant orbital tumor which is a life-threatening condition. It is necessary to determine predictive factors associated with overall survival (OS) following orbital exenteration.MethodsThis was a retrospective, comparative, case series of 39 patients with malignant tumors who underwent orbital exenteration. Patient records were reviewed for age, clinical presentation, preoperative visual acuity (VA), tumor size, surgical margin, tumor invasiveness, recurrent disease, and status of distant metastasis. Kaplan-Meier curves were used to assess OS and event-free survival (EFS). The predictive factors related to OS were identified using multivariate analysis.ResultsThe mean age was 62.9 years (range, 5.5 to 89.7 years), 68.4% presented with VA < 20/400. The mean size of all tumors was 32 ± 18 mm. Distant metastasis at diagnosis was reported in 11 patients (28.2%). Twenty-two patients died during follow-up. The median OS and EFS were 3.89 years and 3.01 years, respectively. The predictive factors for worse OS on multivariate analysis were preoperative VA < 20/400 (adjusted hazard ratio [aHR] 4.67, P = 0.003), tumor size larger than 20 mm (aHR 3.14, P = 0.022,) and positive distant metastasis at diagnosis (aHR 15.31, P < 0.001).ConclusionsThe prognostic factors for poor survival outcome following orbital exenteration were a preoperative VA < 20/400, tumor size > 20 mm, and distant metastasis at diagnosis mostly due to patient negligence.
Highlights
Orbital exenteration is a disfiguring procedure that aims to achieve local control
Data collection Patient records were reviewed for age, gender, presenting symptoms and their duration, preoperative visual acuity (VA) after referral from a primary or secondary care center, indication for surgery, tumor origin, tumor size, histopathological diagnosis, surgical margin, tumor invasiveness, status of distant metastasis, surgical complications, recurrent disease, date of death, and cause of death of deceased patients
Since a high proportion of metastasis was found in patients with clear surgical margins, we propose that micrometastasis occurred prior to orbital exenteration
Summary
Orbital exenteration is a disfiguring procedure that aims to achieve local control. It is commonly a part of the management of malignant orbital tumor which is a life-threatening condition. It is necessary to determine predictive factors associated with overall survival (OS) following orbital exenteration. Orbital exenteration is a disfiguring procedure which removes all of the orbital contents including the periosteum and eyelids with or without the orbital bone. A number of diseases require orbital exenteration to achieve local control; for example, destructive tumors that have spread to the orbit, lacrimal gland malignancies, and fungal infections. Most publications on predictive factors associated with survival outcomes following orbital exenteration were reported from developed countries.
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