Primary Lacrimal Sac Tumors with Extension into Vicinity: Outcomes with Endoscopy-Assisted Modified Weber-Ferguson’s Approach

Abstract

Purpose

To evaluate the outcomes of endoscopy-assisted modified Weber-Ferguson’s approach in the management of primary lacrimal sac tumors with extension into the neighboring tissues.

Methods

A retrospective interventional study was performed on all patients with lacrimal sac tumors treated with the endoscopy-assisted modified Weber-Ferguson approach between January 2010 and June 2022 at the Shanghai Ninth People’s Hospital, China. Data assessed include demographics, clinical presentations, imaging features, surgical techniques, histopathology, adjuvant modalities of management, complications, and outcomes.

Results

A total of 13 patients were included in the analysis. Epiphora and palpable mass lesion were the presenting complaint in 84.6% (11/13) of the patients. Nearly half of the patients (46.1%, 6/13) were misdiagnosed as lacrimal duct obstruction. All the lacrimal sac tumors in the present series showed uneven enhancement on T1-weighted MRI imaging. Postoperatively, 84.6% (11/13) patients recovered well with excellent esthetics and were disease-free after a mean follow-up of 58.6 months. Two patients who underwent additional exenteration developed recurrence and succumbed (at 41 and 96 months follow up) while they were on palliative chemoradiation.

Conclusion

The endoscopic-assisted modified Weber-Fergusson surgical approach is effective in providing better visibility and accessibility to lacrimal sac tumors with extension into neighboring tissue.

Keywords:

• Lacrimal sac tumors
• Epiphora
• Modified Weber-Ferguson’s
• endoscopy-assisted
• Lacrimal

Authors’ contributions

Leilei Zhang, Caiwen Xiao, and Mohammad Javed Ali designed the research. XueRu Liu, Wenyue Zhang, and Lunhao Li performed the experiments. Leilei Zhang, Mohammad Javed Ali, and Wenyue Zhang analyzed the data. Leilei Zhang wrote the manuscript. Fan Yang drew the schematic diagrams. All authors contributed to manuscript revision, read, and approved the submitted version. Caiwen Xiao and Mohammad Javed Ali discussed and supervised the project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

There is no supplementary data. The patient data is available with the senior authors, Caiwen Xiao and can be obtained upon request.

Additional information

Funding

This work was supported by National Natural Science Foundation of China (81972524, 81602366), and the Science and Technology Commission of Shanghai (17DZ2260100). Mohammad Javed Ali is supported by Hyderabad Eye Research Foundation. This work was supported by Science and Technology Commission of Shanghai Municipality.