Department of Orbital Oculoplastic and Lacrimal Surgery, The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
Orbit. 2023 Oct;42(5):536-544. doi: 10.1080/01676830.2022.2141803. Epub 2023 Jan 8.
Orbital exenteration of periocular tumors complicated by orbital invasion is a heavy burden for patients and leads to disfiguring cosmesis and loss of vision. Here, we report our experience with globe-sparing surgery in a series of patients with periocular malignancies other than basal cell carcinoma (BCC), all exhibiting anterior orbital invasion.
In this consecutive case series, we examined medical records of all patients between 2000 and 2018 with periocular malignancies (other than BCC) invading the anterior orbit (without extraocular muscle or scleral invasion) treated by one orbital surgeon (DP). The main outcome measures included local recurrence, regional and distant metastasis, survival, and visual acuity.
Nine patients were identified. Of the non-BCC cancers invading the orbit, squamous cell carcinoma (SCC) (44.4%) was the most prevalent type in our series. Excision included the removal of visibly distinguishable tumor and a free clinical margin of up to 5 mm with histological confirmation of radicality of the invasive tumor component. Reconstruction was achieved by a variety of oculoplastic reconstructive procedures. At a mean follow-up of 70 months (range 11-177 months), 8 out of 9 patients were still alive. Recurrence occurred in two patients with conjunctival melanoma (CM), and they were again treated with wide excision. Postoperative visual acuity remained stable or improved.
This retrospective case series demonstrates that globe-sparing excisional surgery can be considered in selected cases of periocular malignancies other than BCC with anterior orbital invasion, thus avoiding cosmetic disfigurement and loss of vision due to orbital exenteration.
眼眶周围肿瘤侵犯眼眶的眶内容剜除术对患者来说负担沉重，会导致毁容和视力丧失。在这里，我们报告了一系列除基底细胞癌（BCC）以外的眼眶恶性肿瘤患者的眼球保留手术经验，所有患者均表现为前眶侵犯。
在这项连续病例系列研究中，我们检查了 2000 年至 2018 年间由一位眼眶外科医生（DP）治疗的所有眼眶周围恶性肿瘤（非 BCC）侵犯前眶（无眼外肌或巩膜侵犯）的患者的病历。主要观察指标包括局部复发、区域和远处转移、生存率和视力。
确定了 9 名患者。在侵犯眼眶的非 BCC 癌症中，鳞状细胞癌（SCC）（44.4%）是我们系列中最常见的类型。切除包括肉眼可见的肿瘤切除和 5mm 以内的游离临床切缘，并通过组织学确认侵袭性肿瘤成分的根治性。重建是通过各种眼整形重建手术来实现的。在平均 70 个月（11-177 个月）的随访中，9 名患者中有 8 名仍然存活。两名结膜黑色素瘤（CM）患者复发，并再次接受广泛切除。术后视力保持稳定或改善。
这项回顾性病例系列研究表明，对于前眶侵犯的除 BCC 以外的眼眶周围恶性肿瘤，可考虑行眼球保留切除术，从而避免因眶内容剜除术导致的毁容和视力丧失。
