Long-Term Oncologic Outcomes in Patients Undergoing Orbital Exenteration for Advanced Head and Neck Cutaneous Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.
Abstract
Background
Treatment of head and neck cutaneous squamous cell carcinoma (HNcSCC) with orbital invasion is challenging due to its aggressive local behavior and the limited effectiveness of eye-sparing options in advanced disease. This systematic review and meta-analysis aimed to evaluate the prognostic outcomes in advanced HNcSCC patients undergoing orbital exenteration (OE).
Methods
PubMed, Embase, Web of Science, and ScienceDirect were searched from inception to April 30, 2026, for studies reporting survival, tumor control, and complication outcomes in patients with advanced HNcSCC undergoing OE. Pooled estimates were calculated using a random-effects model, with further sensitivity analysis and meta-regression analysis.
Results
Ten studies comprising 217 patients were analyzed. Most patients were male (83%); median age was 66.3 years. The pooled 2-year overall survival was 73.7% (95% CI, 63.4%-81.9%) and 5-year overall survival 70.8% (95% CI, 56.0%-82.2%). Pooled 2-year and 5-year disease-free survival were 66.1% (95% CI, 42.2%-83.9%) and 51.6% (95% CI, 37.8%-65.2%). Pooled local and regional recurrence were 23.7% (95% CI, 14.0%-37.1%) and 14.0% (95% CI, 3.9%-39.2%), and the pooled complication rate 39.2% (95% CI, 24.1%-56.7%). In meta-regression, the proportion of margin-positive resections was the only covariate associated with local recurrence (β = 0.076 per percentage point; 95% CI, 0.027 to 0.124; p = 0.015; R2 = 100%); no demographic factor was associated with any outcome.
Conclusions
Patients undergoing OE for advanced HNcSCC had moderate survival and locoregional control with substantial morbidity. Evidence directly comparing OE with orbit-preserving approaches remains sparse, and high-quality comparative studies are needed to define the role of eye-sparing strategies in this high-risk population, particularly in the era of neoadjuvant immunotherapy.