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Orbital exenteration: a 15-year study of 38 cases
Arie Y Nemet1, Peter Martin, Ross Benger
1Department of Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia.
Ophthalmic Plastic and Reconstructive Surgery
|November 22, 2007
Summary
Orbital exenteration for cancer with clear margins had a 23.7% recurrence rate, with 18.4% mortality. Dermis-fat grafts improved socket reconstruction aesthetics, but long-term systemic follow-up is crucial.
Area of Science:
- Ophthalmology
- Surgical Oncology
- Oncology
Background:
- Orbital exenteration is a radical surgical procedure for advanced orbital malignancies.
- Assessing outcomes and recurrence patterns after exenteration with clear margins is vital for patient management.
- Understanding factors influencing local and systemic disease spread is crucial for improving survival rates.
Purpose of the Study:
- To evaluate clinical indications and outcomes of orbital exenteration with histologically clear margins.
- To identify factors associated with local and systemic recurrences and mortality post-exenteration.
- To analyze the effectiveness of different socket reconstruction methods.
Main Methods:
- Retrospective case review of orbital exenterations performed at Sydney Eye Hospital (1990-2004).
- Data collected included indications, histopathology, surgical extent, reconstruction techniques, and follow-up recurrence data.
- Analysis focused on outcomes in patients with clear surgical margins.
Main Results:
- Malignant adnexal tumors with secondary intraorbital spread were the primary indication (34/38 cases).
- Recurrence rate was 23.7% (9/38), with 3 local and 6 systemic recurrences.
- Mortality rate was 18.4% (7/38), with dermis-fat grafts showing faster healing and better aesthetic outcomes.
Conclusions:
- Orbital exenteration with clear margins can achieve favorable outcomes, but recurrence remains a concern.
- Dermis-fat grafts enhance aesthetic reconstruction of the exenterated socket.
- Close follow-up, particularly systemic surveillance, is essential due to the risk of late recurrences.
