Orbital Exenteration Trends at a Single Institution From 2011 to 2024.

Area of Science:

• Ophthalmology
• Oncology
• Surgical Oncology

Background:

• Orbital exenteration is a radical surgical procedure for advanced orbital malignancies.
• Recent advancements in immunotherapy and globe-sparing techniques may influence exenteration rates.
• Understanding trends in orbital exenteration is crucial for surgical training and resource allocation.

Purpose of the Study:

• To investigate trends in orbital exenteration rates at a major tertiary care center.
• To assess the impact of immunotherapy and novel surgical techniques on exenteration frequency.
• To analyze diagnosis-specific changes in orbital exenteration over time.

Main Methods:

• Retrospective cohort study of patients undergoing orbital exenteration from 2011-2024.
• Surgical coding data obtained via institutional data brokers and validated by chart review.
• Poisson regression used to analyze incidence trends, comparing 2011-2017 with 2018-2024.

Main Results:

• Total orbital exenterations decreased by 39% (IRR=0.61, p=0.004) in 2018-2024 compared to 2011-2017.
• Significant declines observed for cutaneous squamous cell carcinoma (IRR=0.49, p=0.023) and ocular surface squamous neoplasia (IRR=0.17, p=0.002).
• Sebaceous gland carcinoma exenterations increased (IRR=2.94, p=0.015), while total exenterations showed a 3.9% annual decrease.

Conclusions:

• A significant decline in total orbital exenterations was observed from 2018-2024.
• Declines in exenterations for specific cancers correlate with the introduction of PD-1 inhibitors and immunotherapy.
• Findings suggest a shift in oncologic treatment paradigms, impacting surgical training and resource planning.