Orbital Exenteration at Bascom Palmer Eye Institute: 2002-2021

Abstract

Purpose: Orbital exenteration involves removal of the entire orbital contents including the globe. It is typically reserved for orbital malignancies, the incidence of which have increased. This study aims to evaluate the demographics of patients undergoing orbital exenteration, as well as survival based on disease, status of surgical margins, and surgical technique. Methods: Retrospective chart review. Results: Patients undergoing exenteration were on average 62.7 years old, and the majority were male (63.8%). The most common diagnoses were squamous (41.8%), basal (15.4%), and sebaceous cell carcinoma (11.0%). Total exenteration (59.8%) was the most common surgical technique, and reconstruction was most often performed with a skin graft (60.0%). 20.7% of patients demonstrated tumor recurrence and 17.7% showed metastasis. Additionally, 25.3% of patients demonstrated surgical complications on an average of 12.6 months after the procedure. Most patients were treated with adjuvant therapy (57.1%), most of whom underwent radiation therapy (56.3%). Survival was significantly higher amongst basal cell carcinoma and adenoid cystic carcinoma patients than those with mucormycosis (40.4 and 28.5 vs. 1.8 months) (p=.05). Patients with positive surgical margins (39.4%) showed significantly higher tumor recurrence than those without (35.7% vs 9.5%, p0.5). Conclusion: With an aging population, the incidence of invasive orbital and adnexal tumors has increased over time. Our results support prior literature by suggesting that survival is highly dependent on the predisposing disease, and positive surgical margins significantly increase the risk for tumor recurrence and/or metastasis. There was no statistically significant difference in survival based on surgical or reconstruction technique, which suggests we can successfully perform partial exenterations, including lid-sparing surgery, without affecting disease course and survival. Many patients presenting with advanced disease may have a wider range of treatment options in favor of radical surgery.