Orbital exenteration: The 10-year Massachusetts Eye and Ear Infirmary experience

Abstract

The authors report their experience with orbital exenteration surgery at one academic institution over a 10-year period and review the literature. This retrospective cohort study monitored outcomes of all patients who underwent orbital exenteration surgery at Massachusetts Eye and Ear Infirmary between January 2003 and January 2013. Patients with no follow-up data or survival data were excluded from the study. The main outcome measures were surgical complications, disease status of surgical margins, need for adjuvant treatment, local recurrence, metastases and survival. 23 patients with malignancy and 2 with mucormycosis met inclusion criteria for the study. Surgical procedures included non-lid sparing total exenteration (44%), lid-sparing total exenteration (32%), non-lid sparing partial exenteration (8%) and lid-sparing partial exenteration (16%). 44% underwent additional extra-orbital procedures. Survival rates were 72% at 1 year, 48% at 3 years, and 37% at 5 years. Of patients with malignancies, 48% had clear margins after exenteration. There was no statistically significant difference in survival between patients with negative surgical margins compared to positive margins (p = 0.12). Mortality was highest in patients with melanoma (85.7%) and lowest in patients with non-squamous cell lid malignancies (0%). Our study suggests that the type of disease has a much greater impact on the survival of patients undergoing exenteration surgery than the type of exenteration surgery or the disease status of surgical margins. Patients with non-squamous cell lid malignancies and localized orbital disease have the best prognosis for tumor eradication from this radical and highly disfiguring surgery.

Orbital exenteration and conjunctival melanoma: a 14-year study at the Jules Gonin Eye Hospital

“…In our study, positive surgical margins were associated with a shorter OS according to the log-rank test ( p = 0.002). These results are consistent with those published by Gerring et al [ 13 ], although other authors have not been able to show any OS improvement despite the presence of clear surgical margins [ 4 , 7 , 12 , 28 ]. Another important factor known to affect OS is the presence of synchronous micro-metastases that are suspected to be already present at the time of orbital exenteration.…”

“…These results are in accordance with previous studies. In the current literature, the 1-year OS ranges between 50.5% [ 24 ] and 97% [ 2 ] and the 5-year OS ranges between 37% [ 7 ] and 92% [ 8 ]. Kuo et al have reported a 5-year OS of 92% and they have advocated the need for prompt and aggressive surgical treatment [ 8 ].…”

Orbital Exenteration: A 23-year Report

“…Rahman et al [9] reported that 64 of their 69 cases required exenteration for malignant disease. Other authors have published similar results in their studies: for example, Nagendran et al [8] found 23 of 25 exenterations were for malignancies. Also, in the studies of Bartley et al [7] (n = 100 / 102), Levin and Dutton [11] (n = 93 / 99), and Mohr and Esser [10] (n = 74 / 77), similar results were found.…”

“…The mean age of our patients was 55.43 ± 27 years. The mean age of patients undergoing orbital exenteration is commonly older than 50 years [81115].…”

“…One of the largest historical series of orbital exenteration cases was published in 1989 by the Mayo Clinic and includes 102 patients seen over a 20-year period [7]. Separately, Nagendran et al [8] reported 25 cases of orbital exenteration performed at the Massachusetts Eye and Ear Infirmary over a 10-year period, while Rahman et al [9] analyzed 69 cases of orbital exenteration performed during a 13-year period. Mohr and Esser [10] also reported their experiences with 77 cases and Levin and Dutton [11] had 99 cases, both over a period of 20 years.…”