Outcomes after Orbital Exenteration

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Objective: 1) To report surgical and oncologic outcomes for patients who underwent orbital exenteration for malignancies involving the orbit. 2) To understand rationale behind choice of reconstruction technique used after orbital exenteration. Method: A retrospective study of all patients requiring orbital exenteration for malignancy between April 2000 and April 2010 at a tertiary referral academic institution was performed. Demographic data, treatment details, reconstructive outcomes, and survival/recurrence rates were compiled and disease characteristics predictive of poor outcomes were identified. Results: There were 52 patients requiring orbital exenteration for surgical management of malignancy. Malignant etiology was cutaneous squamous cell carcinoma (SCC) in 24 (46%), sinonasal SCC in 15 (29%), and non-SCC histology in 13 (25%). Recurrence rate at 1 year was 47% for all histologies after orbital exenteration. The majority of recurrences were local (65%). Average time to recurrence was 8.3 months. Surgical margin status had no effect on overall recurrence rate. Radiation therapy was part of the treatment for 73% of patients, with 23% of the overall group having received previous XRT and 50% of the group receiving postoperative radiation. The surgical defect created a communication between the sinonasal cavity and the orbital wound 77% of the time, which correlated with a higher rate of late wound complications ( P = .02). Free flap reconstruction was performed in 83% of patients, with rectus myocutaneous flap being the most common. Overall wound complication rate was 44%. Conclusion: Malignancy requiring orbital exenteration is a complex disease, requiring aggressive and specialized management of both healing and oncologic issues.