Life expectancy following orbital exenteration

Abstract

Orbital exenteration is a physically debilitating procedure that may be a necessity in the management of orbital malignancy. It requires a sensitive multidisciplinary approach, both preoperatively and postoperatively. Providing life expectancy information for patients during preoperative counselling is pertinent to informed consent and in addressing patients' expectations. A retrospective review from one tertiary care centre was undertaken for a cohort of patients who were exenterated for orbital malignancy between 1998 and 2010. The cases were identified using an International Classification of Diseases 10th Revision (ICD-10)-derived database and were analysed using Prism statistical software (V.5.04). Cause of death was ascertained by liaising with the general practitioner and the National Registrar Office for Births, Deaths, and Marriages, Southport, UK. In total, 41 men and 32 women were identified. Mean age was 72 years with 47 cases living and 26 deceased at the time of review. The overall 5-year survival rate in this study was 64%. Kaplan-Meier analysis for basal cell carcinoma (BCC) against non-BCC returned a p value of 0.0199, with an HR of 0.3927 (CI 0.1788 to 0.8626). Kaplan-Meier analysis for cleared against non-cleared margins returned a p value of 0.2890, with an HR of 0.6571(CI 0.3024 to 1.428). Our results represent the highest 5-year survival data to date. However, the overall prognosis for patients who undergo orbital exenteration for malignancy remains poor. We hypothesise that the causes are multi-factorial. We recommend a multidisciplinary approach to the care of these patients, involving head and neck teams, oncology and other appropriate specialties, to optimise outcomes for this vulnerable patient group.

Clinico-Pathological Patterns of Patients Who Underwent Orbital Exenteration in a Tertiary Eye Hospital of Nepal

“…This could be due to the distribution of patient age group in our study, consisting equal number of children and adults with high occurrence of retinoblastoma responsible for exenteration in childhood. We observed orbital tumor as the second most common primary site of tumor responsible for exenteration, which is similar with the findings of other studies (3, 4,8). …”

“…The most common indication for exenteration in our study was retinoblastoma (32.1%), and this was discordant with other literature findings (3 4, 8, 9) which reported that eyelid tumor was the most common etiology responsible for exenteration. This could be due to the distribution of patient age group in our study, consisting equal number of children and adults with high occurrence of retinoblastoma responsible for exenteration in childhood.…”

“…According to geographical locations, reports on common etiologies requiring exenteration variy Rahman et al (3), Wong et al (8) from the United Kingdom and Duman et al (4) from Turkey reported basal cell carcinoma as theleading pathology requiring exenterationwhereas Nemet et al from Australia reported Squamous cell carcinomaas as the most common cause (5). …”

Orbital exenteration for advanced periorbital non-melanoma skin cancer: prognostic factors and survival

“…42,43 Currently, the decision to proceed with conservation of the globe is individualized to the patient based on tumor location, tumor behavior, tumor subtype, reconstruction goals, and patient preference. 18,20,[42][43][44][45] The roles of and interplay between 'globe sparing' surgery and targeted therapy in the treatment of periorbital skin cancer require further study. The inconsistent and in select cases short duration of follow-up is a significant limitation of the study, and therefore the long-term survival data must be interpreted with caution.…”

Vismodegib for Locally Advanced Periocular and Orbital Basal Cell Carcinoma: A Review of 15 Consecutive Cases

“… 12 – 15 Despite evidence that exenteration can achieve surgical cure, 14 , 16 , 17 it is associated with significant morbidity and deformity. 15 , 18 – 20 …”