En bloc excision in malignant tumors of the lacrimal drainage apparatus

Ophthalmic Plast Reconstr Surg. 2006 Sep-Oct;22(5):356-60. doi: 10.1097/01.iop.0000235819.06507.b1.


Purpose: To describe the surgical technique and results of en bloc excision in a series of patients with extensive malignant tumors of the lacrimal drainage apparatus (LDA).

Methods: This was a noncomparative, retrospective chart review of the clinical and pathologic findings of 11 patients presenting with a malignant tumor affecting the LDA who underwent en bloc excision of the lacrimal system.

Results: Of the 11 patients, 7 were male. The mean age at presentation was 58 years (range, 39 to 81 years), and all cases were unilateral. Histopathology revealed 4 squamous cell carcinomas, 3 transitional cell carcinomas, 2 mucoepidermoid carcinomas, and 2 melanomas. Epiphora and a mass were the most common presentations. An external lesion could be identified in 4 cases. Irrigation of the lacrimal system revealed nasolacrimal duct obstruction in 2 cases and common canaliculus obstruction in another 2 patients. The entire LDA and surrounding bony tissues were excised through a lateral rhinotomy approach. Adjuvant radiotherapy was given in 4 cases. Nine patients remain alive and well after a mean follow-up of 2 years (range, 6 months to 7 years). Three cases showed distant disease and 2 patients died of metastatic melanoma involvement.

Conclusions: The use of en bloc excision as a radical treatment to remove the complete LDA and surrounding bony structures affords good local tumor control and may provide the best opportunity for enhanced patient survival.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma / diagnostic imaging
  • Carcinoma / pathology
  • Carcinoma / surgery*
  • Eye Neoplasms / diagnostic imaging
  • Eye Neoplasms / pathology
  • Eye Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Lacrimal Apparatus / surgery*
  • Male
  • Melanoma / diagnostic imaging
  • Melanoma / pathology
  • Melanoma / surgery*
  • Middle Aged
  • Ophthalmologic Surgical Procedures / methods*
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Treatment Outcome