En Bloc Orbitectomy in the Management of Advanced Orbital Cancer: A Retrospective Study of Seven Different Carcinomas

An en bloc orbitectomy is one of the most invasive surgical procedures in the orbit, primarily used to remove advanced malignancies, ensure negative resection margins, and local cancer control. This study examines the indications, clinical features, outcomes, and survival rates of patients who underwent this surgery for periocular and orbital malignancies.

A retrospective consecutive case series of seven patients with various orbital carcinomas managed with en bloc orbitectomy from 2018-2023 at the University Hospital in Pilsen, Czech Republic, was conducted. Minor surgeries and other diagnoses were excluded.

The study included seven patients, with an average age of 68.7 years (range 50-83, median 74). Orbitectomy was part of salvage surgery in two patients and debulking in one. R0 resection was achieved in only 50% of cases; defects were reconstructed with a free anterolateral thigh (ALT) flap in one case and local flaps in others. Therapeutic neck dissection was performed in three patients directly after surgery, in one case 15 months after orbitectomy.

A thorough examination of indications, patient and tumor features, and reconstructive possibilities should precede an en bloc orbitectomy. Despite being highly invasive, it should be adequately indicated to avoid less invasive surgeries that could complicate radical surgery and impair disease control.