Purpose

Malignant lacrimal sac tumours are rare neoplasms for which published survival data remain insufficient to guide primary surgical intervention. We present oncological outcomes from a tertiary referral centre spanning three decades.

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Methods

A retrospective cohort study of patients presenting with malignant lacrimal sac tumours at a single tertiary centre between 1985 and 2021. Patients with benign pathology or incomplete records were excluded. OS and DFS were estimated by Kaplan–Meier analysis with five-year follow-up.

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Results

Of 35 patients identified, 32 were included after excluding 3 with incomplete records. The cohort was 53% female (17/32), mean age 73 years (range 37–106), with 31 unilateral and 1 bilateral tumour.
Histological subtypes included squamous cell carcinoma (12/32), lymphoma (7/32), transitional cell carcinoma (5/32), mucoepidermoid carcinoma (3/32), and single cases of adenocarcinoma, sinonasal neuroendocrine carcinoma, melanoma, multiple myeloma, and solitary fibrous tumour. Surface-derived epithelial tumours accounted for 53% (17/32).
Most patients — 26/32 (81%) — underwent localised resection with adjuvant radiotherapy or chemotherapy. Six patients (19%) with advanced locoregional disease proceeded to primary orbital exenteration.
Whole-cohort 3- and 5-year OS were 90% (95% CI: 72–97%) and 86% (95% CI: 66–95%); DFS were 90% (95% CI: 72–97%) and 78% (95% CI: 58–90%). In the localised resection group, 3- and 5-year OS were 92% (95% CI: 72–98%) and 87% (95% CI: 65–96%); DFS were 92% (95% CI: 72–98%) and 78% (95% CI: 55–90%).

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Conclusion

Localised resection with adjuvant therapy yielded 5-year OS and DFS of 87% and 78% respectively. Prognosis remained poor in those with advanced disease despite exenteration. Given the substantial morbidity of orbital exenteration, these results support a more conservative surgical approach in selected patients. Multicentre collaboration is needed to strengthen the evidence base for this rare tumour site.

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Additional Authors

First name	Last name	Base Hospital / Institution
Maria Susan	Varughese	Institute of Ophthalmology
Mohsan	Malik	Moorfields Eye Hospital
Simon	Gane	Moorfields Eye Hospital
David	Verity	Moorfields Eye Hospital

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