Importance: Although orbital exenteration may be lifesaving, it is a disfiguring procedure that comes with significant long-term impact on patients. Survival benefits must outweigh the physical and psychological impact of surgery for each patient. Clarification of prognostic factors is essential for appropriate orientation of treatment.
Objective: To identify prognostic factors that influence survival of patients who have undergone orbital exenteration for malignant periocular, ocular adnexal and sinonasal tumors in our center. We also describe the overall survival and disease-free survival following orbital exenteration.
Design, Setting and Participants: Retrospective review of the medical records of adult patients undergoing orbital exenteration in a tertiary hospital between 1993 and 2017.
Exposures: Orbital exenteration for periocular, ocular adnexal and sinonasal malignant tumors.
Main Outcomes and Measures: Patient demographics, primary tumor location, bone erosion, history of treatment, resection extending beyond the orbital exenteration, final histological diagnosis, surgical margins, perineural invasion, lymphovascular invasion and adjuvant therapy were recorded. Log-rank tests were used to test for difference in Kaplan-Meier survival curves among various potential prognostic factors.
Results: A total of 69 patients (41 men, 27 women) were included, fifty-six with periorbital and ocular adnexal malignancies and 13 with sinonasal tumors. Mean age at surgery was 67.2 years and average follow-up time was 66.4 months. Considering all patients, the 1 and 5-year overall survival were respectively 88.0 % and 56.0 %. The 1 and 5-year disease-free survival were respectively 85.5 % and 59.6 %. Kaplan-Meier analysis for cutaneous malignancies demonstrated that age over 75 years and lymphovascular invasion were associated with a worse outcome. Analysis for sinonasal malignancies demonstrated that age over 75 years, positive surgical margins, lymphovascular invasion and perineural invasion were predictive of worse outcomes.
Conclusions and Relevance: Despite the aggressive nature and disfiguring impact of orbital exenteration, it provides an acceptable overall survival and disease-free survival rate for patients suffering from periocular, ocular adnexal and sinonasal malignancies. When considering surgery, we recommend a multidisciplinary team approach to achieve disease-free surgical margins. Lymphovascular invasion should be considered as a negative prognostic factor for periocular and ocular adnexal malignancies when considering adjuvant therapy. Our data also suggest that patient age at surgery should be taken into consideration for orientation of treatment.