Endoscopic Endonasal Dacryocystectomy for Tumors Involving the Nasolacrimal Duct and Lacrimal Sac

Abstract Endoscopic endonasal dacryocystorhinostomy is performed to treat epiphora in patients with chronic dacryocystitis. However, the potential application of an endonasal dacryocystectomy for malignancies involving the lacrimal system (lacrimal sac and nasolacrimal duct) has not been sufficiently investigated. This study aims to assess the feasibility of an endonasal dacryocystectomy and to investigate its efficacy with clinical case scenarios. An endoscopic endonasal dacryocystectomy was conducted on two cadaveric specimens (four sides). An endonasal dacryocystectomy for tumors involving the lacrimal system was performed in six patients. The feasibility of performing an endonasal dacryocystectomy was assessed on cadaveric dissection, and the efficacy of endonasal dacryocystectomy for patients with involvement of the lacrimal system was evaluated. Endonasal extirpation of the lacrimal system was feasible on four cadaveric sides. For five patients with sinonasal malignancies (two adenoid cystic carcinoma, one squamous cell carcinoma, two mucosal melanoma) and one with lacrimal sac melanoma, endonasal dacryocystectomy was successfully performed and negative margins achieved in all six patients. One patient harbored postoperative epiphora, no other comorbidities were detected. With an average follow-up of 18 months, no regional recurrence at the lacrimal system was detected. To perform an endoscopic endonasal dacryocystectomy is feasible on cadaveric specimens. For sinonasal malignancies secondary involving the lacrimal system, it is possible to conduct an endonasal resection when the indication is appropriately selected.