[Does orbital exenteration still has a place in 2019?]

Area of Science:

• Ophthalmology
• Surgical Oncology
• Head and Neck Surgery

Background:

• Orbital exenteration is a radical surgical procedure for orbital cancers, often resulting in significant disfigurement.
• The procedure's impact on overall survival and the advent of novel molecular therapies necessitate a re-evaluation of its role.

Observation:

• A literature review of 19 articles identified eyelid tumors, particularly basal cell carcinoma, as the primary indication for orbital exenteration.
• Complications include cerebrospinal fluid leakage, ethmoid fistula, and infection, with varying rates of R0 tumor resection.
• Overall survival rates at 1 and 5 years post-exenteration are 83% and 65%, respectively.

Findings:

• Risk factors for poor survival include advanced age, unfavorable tumor histology, non-R0 resection, and locally advanced tumors.
• Recent studies show promising outcomes for locally advanced cancers using targeted therapies and immunotherapies, potentially avoiding exenteration.
• Orbital exenteration achieves satisfactory local disease control, though it has not demonstrated an overall survival benefit.

Implications:

• Orbital exenteration remains a crucial part of the therapeutic armamentarium for orbital malignancies.
• The evolving landscape of targeted therapies and immunotherapies may significantly influence future treatment decisions, potentially reducing the reliance on exenteration.