Orbital Exenteration Trends at a Single Institution From 2011 to 2024.

[PURPOSE] The primary objective was to investigate the trends in orbital exenteration rates at a large tertiary care center, particularly in the context of recent advancements in immunotherapy, targeted agents, and globe-sparing surgical techniques, which have significantly impacted patient management.

[METHODS] The authors conducted a retrospective cohort study at the University of Miami. Patients who underwent orbital exenterations from 2011 to 2024 were identified by obtaining surgical coding data via institutional data brokers and validated through a rigorous surgical chart review. The authors used Poisson regression with robust standard errors to compare incidence trends, using the Florida state population as an offset. The analyses compared 2011 to 2017 with 2018 to 2024 and examined year-by-year variation, ensuring a robust and reliable study.

[RESULTS] A total of 179 exenteration cases were identified. Compared with 2011 to 2017, total exenterations decreased by 39% in 2018 to 2024 (incidence rate ratio [IRR] = 0.61; p = 0.004). Significant declines were also observed from 2018 to 2024 for cutaneous squamous cell carcinoma (IRR = 0.49; p = 0.023) and ocular surface squamous neoplasia (IRR = 0.17; p = 0.002), while sebaceous gland carcinoma increased (IRR = 2.94; p = 0.015). Year-over-year analysis estimated a 3.9% annual decrease in total exenterations.

[CONCLUSIONS] This study revealed a significant decline in total orbital exenterations from 2018 to 2024 and diagnosis-specific declines in exenterations for cutaneous squamous cell carcinoma and ocular surface squamous neoplasia compared with 2011 to 2017. This trend coincides with the introduction of Programmed Cell Death Protein 1 (PD-1) inhibitors and other immunotherapies, first approved by the United States Food & Drug Administration in 2018, and suggests they may have contributed to the observed decline. These findings reflect shifting oncologic treatment paradigms and underscore important implications for surgical training and resource planning.