Orbital exenteration: Our experience at a tertiary cancer center

Abstract

Abstract Background: Orbital exenteration (OE) is a radical procedure, involving the removal of all orbital contents including orbital fat, globe, conjunctival sac, and part or all of eyelids. It is indicated for malignant tumors of orbital structures not treatable with simple excision or radiotherapy. Lid-sparing OE can be used in cases where the orbital tumors does not involve the eyelids. Aim: The aim of the study is to describe our experience of OE at a tertiary cancer center over 5 years. Materials and Methods: This is a retrospective study. Surgical records of patients, who underwent OE from June 2017 to June 2022, were examined to determine demographics, indications, site of lesions, histological diagnosis, any previous surgery, neoadjunctive and adjunctive treatments, complications, recurrences, and Computed tomography scan/magnetic resonance imaging findings. Settings and Design: This is a descriptive, observational, retrospective study. Statistical Method: Data were entered in Microsoft Excel version 2023 and analyzed in the form of numbers and percentages. Results: A total of 12 cases were included in the study. The mean age of patients was 64.33 years. Presenting symptoms were protrusion of an eyeball in four cases, ocular surface growth in four, decreased vision in one, and eyelid mass in three cases. Three cases were of basal cell carcinoma (25%), one of choroidal melanoma (8.33%), five of invasive squamous cell carcinoma (SCC) (41.67%), two of sebaceous gland carcinoma (16.67%), and one of recurrent optic nerve schwannoma (8.33%). The site of origin of tumor was conjunctiva (n = 5) in 41.67%, eyelid (n = 5) in 41.67%, globe in (n = 1) 8.33%, and orbit in (n = 1) 8.33% of cases. Surgical margins were free of tumor in 10 patients, but positive in two patients. The mean duration of follow-up was 8.08 months with a range of 2–33 months. Conclusions: The most common indication for OE is SCC of conjunctiva. OE is still indicated in some cases of orbital tumors, although recent advances in earlier diagnosis and alternative conservative treatment options are available.