Mortality following exenteration for malignant tumours of the orbit

Abstract

Background: Orbital exenteration is a rare, but disfiguring procedure reserved for the treatment of locally invasive malignancy or potentially life threatening orbital neoplasms, when less destructive techniques are inadequate. The authors report their experience and analyses of 64 cases of orbital exenteration performed over a 13 year period, looking specifically at key factors affecting mortality associated with such a destructive surgical procedure. Methods: Records were reviewed retrospectively of all patients who had undergone exenteration of the orbit from 1 January 1991 to 1 April 2004 inclusive, at the Manchester Royal Eye Hospital. In all cases of deceased individuals, the cause of death was determined by liaison with the general practitioner and local health authority. Duplicate death certificates were requested for all deceased patients from the Registrar for Births, Deaths, and Marriages, Southport, UK. Kaplan-Meier analysis was used to estimate survival following exenteration. Results: Overall, 1 year survival post-exenteration was high at 93%. After 3 years this had fallen to 67%, followed by 57% after 5 years, and 37% at 10 years. 13 patients died as a direct result of the orbital tumour. A further nine died of unrelated medical conditions, and two patients succumbed to malignant processes originating elsewhere in the body. There was no difference in survival rate at 3 years (p = 0.99) and 5 years (p = 0.454) between those with clear resection margins and those without. Conclusion: In this study it was found that there was an overall mortality rate of 38% over 12 years. The presence of clear surgical margins, although reassuring for the surgeon, should not be regarded as an indication of cure. However, an overall 1 year survival of 93% and a 10 year survival of 37% are reassuring in that a proportion of individuals achieve surgical cure following exenteration. 38% of patients died as a result of other medical causes over the 12 year follow up.

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

“…This is lower than the rates of positive permanent margins between 28 and 47% reported in other series. 6,17,19 One possible explanation for this is that the multidisciplinary approach to tumor resection typically used at this tertiary referral cancer center enabled additional surgical procedures to be performed at the same time as the exenteration in order to optimize tumor control. In our series, multivariate analysis showed that the presence of a positive final surgical margin was the only potential factor that was associated with a worse prognosis.…”

“…Interestingly, positive final surgical margins have not been associated with a worse prognosis in other series. 6,17 It may be hard to compare numbers between different retrospective series because of the heterogeneity of inclusion criteria. This is possibly due to lower overall rates of positive margins in this series as mentioned above, as well as higher rate of micrometastasis of other tumor types such as melanoma, malignant sarcomas, adenoid cystic carcinoma, sinonasal tumors, primary orbital tumors, and lacrimal tumors, which were not included in our study.…”

“…Clear margin status, however, has previously not been associated with improved prognosis in patients undergoing exenteration for malignancies with orbital invasion. 6,17,18 However, these studies represent a significant mix of histologic subtype (including melanoma) and site of origin (including sinonasal and primary orbital). Due to the relative rarity of orbital invasion in periorbital skin cancers, there are few reported studies that specifically examine orbital exenteration for non-melanoma malignancies arising from periocular tissue, and none that address prognostic factors and survival in this group.…”

“…5 When orbital invasion of BCC occurs, it has a similarly poor prognosis as other periorbital malignancies, such as SCC. 6 While SCC is a less common periocular malignancy, 20-30% of periocular SCC is multifocal at the time of diagnosis 1,7 with regional involvement in between 1 and 24.3% of cases. 7,8 Perineural invasion occurs in 3-14% of squamous cell carcinomas and is associated with a worse prognosis.…”

Characteristics of Eye Tumor in Children

“…Chemotherapy can be performed both before surgery to reduce the tumor size, and after surgery to prevent tumor regrowth. 6,9,19 Surgery is frequently performed to prevent tumor 2,6,20 In this study, no subjects underwent radiotherapy. Doctors often decide to only observe when the tumor mass is still very small, seems unthreatening, and has a probability of spontaneous regression.…”