Combined External, Endoscopic, Endonasal-Assisted En Bloc Resection of Malignant Tumors From the Lacrimal Drainage System

Purpose: The aim of this study is to describe a minimally invasive technique of en bloc resection of malignant tumors from lacrimal drainage system (LDS). Methods: This was a noncomparative, retrospective chart review of the clinical and pathologic findings of patients presenting with a LDS malignant tumor who underwent endoscopic prelacrimal recess approach with a small external incision for en bloc excision of the LDS. Results: A total of 12 patients from April 2010 to July 2017 were reviewed in this study. Of the 12 patients, 7 were males. The mean age was 51 years (range, 38–66 years), and all cases were unilateral. Histopathology revealed 3 adenoid cystic carcinomas, 2 squamous cell carcinomas, 2 melanomas, and 1 each of papilloma with carcinoma, papillary squamous cell carcinoma, mucoepidermoid carcinoma, B-cell lymphoma, and natural killer/T-cell lymphoma. Epiphora and a mass were the most common presentations. Adjuvant radiotherapy was given in 6 cases after surgery. Eleven patients remain alive and mean disease-free survival time was 25 months (range, 3–78 months). Two cases with malignant melanoma showed recurrence and 1 patient died of metastatic involvement. Conclusion: Endoscopic endonasal approach combined with a small external incision is efficient method for the management of tumors arising from the LDS.