Survival outcomes after orbital exenteration for recurrent or previously treated orbital malignancies: impact of margin status and metastatic spread

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BACKGROUND: Orbital exenteration is a radical procedure used in selected orbital malignancies, yet survival outcomes vary widely, particularly in recurrent or previously treated disease. We evaluated the association of pathological stage (nodal and/or distant metastasis status) and margin status with overall survival (OS) and disease-free survival (DFS) in patients undergoing exenteration for recurrent or previously treated orbital cancers. METHODS: We retrospectively analyzed 39 patients who underwent orbital exenteration between 2017 and 2024. Patients were categorized as localized disease (pN0/pM0) or advanced disease with nodal and/or distant metastasis (pN + and/or pM+). Survival was estimated using Kaplan-Meier analysis and compared using the log-rank test. Median follow-up was 365 days. Margins were classified as R0 or R1. RESULTS: Of the 39 patients, 24 (61.5%) had localized disease and 15 (38.5%) had advanced disease with nodal and/or distant metastasis; 6 patients (15.4%) had positive margins. 24-month OS was 78% in localized disease versus 33% in patients with nodal and/or distant metastasis (p = 0.011). Median OS was not reached in localized disease and was 13 months in patients with nodal and/or distant metastasis. 24-month DFS was 62.5% versus 33% (p = 0.017). R1 margins were associated with markedly worse outcomes: 24-month OS 0% vs. 75.8% for R0, and all R1 patients recurred within 12 months. Sensitivity analysis excluding < 6-month follow-up confirmed these findings. CONCLUSIONS: Nodal and/or distant metastatic status and positive surgical margins were associated with worse survival outcomes after orbital exenteration for recurrent or previously treated orbital malignancies. Most adverse events occurred within the first postoperative year, suggesting a clinically relevant early risk period. Given the histological heterogeneity of the cohort, these findings should be interpreted as prognostic patterns in a salvage orbital oncology population and require validation in larger disease-specific series.

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