Abstract
Objectives
This study aimed to analyse the disease-free survival (DFS), overall survival (OS) and risk factors after orbital exenteration in patients with periorbital, conjunctival and primary intraorbital carcinomas.
Methods
Patients undergoing orbital exenteration due to a primary carcinoma between March 2000 and March 2018 were included in this retrospective study. Risk factors in all the patients were evaluated using univariate and multivariate analyses.
Results
In total, 97 patients were enroled in this study. The most common tumours were conjunctival carcinoma (35 cases), squamous cell carcinoma of the skin (27 cases) and basal cell carcinoma (20 cases). The median follow-up period was 36 months. The average age of the patients was 67.3 years (range, 29–93 years). In all the patients, OS was 85% after 1 year and 69% after 5 years, while DFS was 71% after 1 year and 55% after 5 years. Univariate analysis of OS revealed that the following parameters were predictive of a poor prognosis: localisation, neck dissection, lymph node metastases, lymphatic invasion, perineural invasion, resection margins and immunosuppression. Multivariate analysis revealed resection margins as the only independent risk factor.
Conclusion
Orbital exenteration is rarely necessary in patients with periorbital, conjunctival and primary intraorbital carcinomas; however, it can be performed as an ultima ratio treatment with a curative intent. Clear margins can be achieved in most cases. OS and DFS are not significantly different in the subgroups. In most cases, recurrence occurs within the first 2 years.
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References
Shi Y, Jia R, Fan X. Ocular basal cell carcinoma: a brief literature review of clinical diagnosis and treatment. OncoTargets Ther. 2017;10:2483–9.
Silverman N, Shinder R. What’s new in eyelid tumors. Asia-Pac J Ophthalmol. 2017;6:143–52.
Malhotra R, Huilgol SC, Huynh NT, Selva D. The Australian Mohs database, part I: periocular basal cell carcinoma experience over 7 years. Ophthalmology. 2004;111:624–30.
Levin PS, Dutton JJ. A 20-year series of orbital exenteration. Am J Ophthalmol. 1991;112:496–501.
Gunalp I, Gunduz K, Duruk K. Orbital exenteration: a review of 429 cases. Int Ophthalmol. 1995;19:177–84.
Esmaeli B, Ahmadi MA, Youssef A, Diba R, Amato M, Myers JN, et al. Outcomes in patients with adenoid cystic carcinoma of the lacrimal gland. Ophthal Plast Reconstr Surg. 2004;20:22–6.
Shields JA, Shields CL, Gunduz K, Cater J. Clinical features predictive of orbital exenteration for conjunctival melanoma. Ophthal Plast Reconstr Surg. 2000;16:173–8.
Croce A, Moretti A, D’Agostino L, Zingariello P. Orbital exenteration in elderly patients: personal experience. Acta Otorhinolaryngol Ital. 2008;28:193–9.
Goldberg RA, Kim JW, Shorr N. Orbital exenteration: results of an individualized approach. Ophthal Plast Reconstr Surg. 2003;19:229–36.
Kovacevic PT, Visnjic MM, Kovacevic TT, Radojkovic MR, Stojanovic MR. Extended orbital exenteration in the treatment of advanced periocular skin cancer with primary reconstruction with a galeacutaneous flap. Scand J Plast Reconstr Surg Hand Surg. 2009;43:325–9.
Rabey N, Abood A, Gillespie P, Athanassoglou V, Rene C, Malata CM. Reconstruction of complex orbital exenteration defects: a single center’s experience with a five-year follow-up. Ann Plast Surg. 2014;73:158–63.
Roche P, Timon C. Orbital exenteration in periorbital malignancies. Surgeon. 2012;10:189–93.
Taylor A, Roberts F, Kemp EG. Orbital exenteration-a retrospective study over an 11 year period analyzing all cases from a single unit. Orbit. 2006;25:185–93.
Zhang Z, Ho S, Yin V, Varas G, Rajak S, Dolman PJ, et al. Multicentred international review of orbital exenteration and reconstruction in oculoplastic and orbit practice. Br J Ophthalmol. 2017;0:1–5.
Hanasono MM, Lee JC, Yang JS, Skoracki RJ, Reece GP, Esmaeli B. An algorithmic approach to reconstructive surgery and prosthetic rehabilitation after orbital exenteration. Plast Reconstr Surg. 2009;123:98–105.
Kiratli H, Koc I. Orbital exenteration: institutional review of evolving trends in indications and rehabilitation techniques. Orbit. 2018;37:179–86.
Kuo CH, Gao K, Clifford A, Shannon K, Clark J. Orbital exenterations: an 18-year experience from a single head and neck unit. ANZ J Surg. 2011;81:326–30.
Rahman I, Cook AE, Leatherbarrow B. Orbital exenteration: a 13 year Manchester experience. Br J Ophthalmol. 2005;89:1335–40.
Paridaens AD, McCartney AC, Minassian DC, Hungerford JL. Orbital exenteration in 95 cases of primary conjunctival malignant melanoma. Br J Ophthalmol. 1994;78:520–8.
Shields JA, Shields CL, Demirci H, Honavar SG, Singh AD. Experience with eyelid-sparing orbital exenteration: the 2000 Tullos O. Coston Lecture. Ophthal Plast Reconstr Surg. 2001;17:355–61.
Iuliano A, Strianese D, Uccello G, Diplomatico A, Tebaldi S, Bonavolonta G. Risk factors for orbital exenteration in periocular Basal cell carcinoma. Am J Ophthalmol. 2012;153:238–41.e1.
Bartley GB, Garrity JA, Waller RR, Henderson JW, Ilstrup DM. Orbital exenteration at the Mayo Clinic. 1967-1986. Ophthalmology. 1989;96:468–73.
Rahman I, Maino A, Cook AE, Leatherbarrow B. Mortality following exenteration for malignant tumours of the orbit. Br J Ophthalmol. 2005;89:1445–8.
Wong JC, Thampy R, Cook A. Life expectancy following orbital exenteration. Br J Ophthalmol. 2015;99:1–4.
Simons JN, Robinson DW, Masters FW. Malignant tumors of the orbit and periorbital structures treated by exenteration. Plast Reconstr Surg. 1966;37:100–4.
Gerring RC, Ott CT, Curry JM, Sargi ZB, Wester ST. Orbital exenteration for advanced periorbital non-melanoma skin cancer: prognostic factors and survival. Eye. 2017;31:379–88.
Kyllo RL, Brady KL, Hurst EA. Sebaceous carcinoma: review of the literature. Dermatologic surgery: official publication for American Society for. Dermatologic Surg. 2015;41:1–15.
Schadendorf D, Lebbe C, Zur Hausen A, Avril MF, Hariharan S, Bharmal M, et al. Merkel cell carcinoma: epidemiology, prognosis, therapy and unmet medical needs. Eur J Cancer. 2017;71:53–69.
Iannetti G, Valentini V, Rinna C, Ventucci E, Marianetti TM. Ethmoido-orbital tumors: our experience. J Craniofac Surg. 2005;16:1085–91.
Paridaens AD, Minassian DC, McCartney AC, Hungerford JL. Prognostic factors in primary malignant melanoma of the conjunctiva: a clinicopathological study of 256 cases. Br J Ophthalmol. 1994;78:252–9.
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Baum, S.H., Pförtner, R., Manthey, A. et al. Periorbital, conjunctival and primary intraorbital carcinomas: Survival and risk factors after orbital exenteration. Eye 35, 1365–1376 (2021). https://doi.org/10.1038/s41433-020-1055-1
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DOI: https://doi.org/10.1038/s41433-020-1055-1
