Orbital exenterations: an 18-year experience from a single head and neck unit

Background: To review the outcomes of the patients who undergo orbital exenteration for malignancy. Methods: A retrospective review of patients who underwent orbital exenteration performed at Royal Prince Alfred and Concord Hospitals between 1990 and 2008. Results: A total of 38 patients were identified. The most common malignancies were squamous cell carcinoma (14 cutaneous and five mucosal origin), basal cell carcinoma (12 cutaneous) and melanoma (five patients). Orbital invasion was the main indication for orbital exenteration. Additional procedures were performed in 29 (76%) patients at the time of exenteration, including craniotomies in eight patients and maxillectomy in 15 patients. Flap reconstructions were required in 35 (92%) patients, including 33 free flap repairs and two local flap repairs. Post-operative complications included cerebrospinal fluid leak (16%) and wound-related complications (13%). The disease-specific survival rate was 97% at 1 year and 92% at 5 years. The local control rate was 83% at 1 year and 55% at 5 years. Fifty per cent of patient mortality and 63% of local recurrence occurred within the first post-operative year. Conclusions: In this series, locoregional control and survival were high, suggesting that aggressive surgical measures such as orbital exenteration are not unreasonable in well-selected patients. Free flap reconstruction is a reliable reconstructive technique which may reduce major complications. The first post-operative year is the most important period when monitoring for recurrence.