Orbital exenteration in the management of orbital and periorbital tumours: Factors related to treatment outcomes

The aim of this study was to evaluate the indications for surgery, patient and healthcare delays, ophthalmic status, challenges of management, complications, disease-free survival (DFS), and overall survival (OS) of patients treated by orbital exenteration at a tertiary care centre. Patients who underwent orbital exenteration during an 18-year period (2005-2022) were identified from the Helsinki University Hospital (Helsinki, Finland). Demographic and medical data were retrieved. Sixty-nine patients were included. Median age was 74 years (range, 7-93 years). The most common operative indication for exenteration was a malignant tumour (99%). Histopathological types that were most frequently encountered were uveal melanoma in 10 (14%), basal cell carcinoma in 9, (13%) and cutaneous squamous cell carcinoma in 8 (12%) patients. Orbital exenteration could have been avoided in 32 (46%) patients if the primary surgery had been performed with sufficient margins and without delay. The median follow-up time was 16 months (range, 0-169 months). At the end of follow-up, 34 (49%) patients had no evidence of disease, 12 (17%) were alive with disease and 23 (33%) had died of the disease. Kaplan-Meier analysis revealed 1- and 2-year DFS of 74% and 67%, respectively. One- and 2-year OS were 77% and 69%, respectively. Selected periorbital malignancies, especially those with insufficient primary treatment or with treatment delay, may warrant exenteration. Given the diverse origins of malignancies, a multidisciplinary approach, including ophthalmological consultation, appears to be the optimal strategy for these patients.