Need for Lacrimal Bypass Surgery after Medial Canthal Tumor Resection: Survey of Current Practices

Abstract

Christopher J. Calvano, J. Javier Servat, Evan H. Black

Objective: No ideal monitoring period exists before conjunctivodacryocystorhinostomy (CDCR) after excision of medial canthal tumors. This study seeks to define current clinical practices via a survey of oculoplastic and orbital surgeons. Methods: An online survey of medial canthal tumor management was offered via email to ASPORS members. Tumors included: basal cell carcinoma (BCC), squamous cell carcinoma (SCC), sebaceous cell carcinoma (SebC), melanoma (M), keratoacanthoma (KAC), and other adnexal cancers. Results: 87 members responded. Most surgeons follow patients at intervals no longer than 3-6 months, with monthly exams initially for SebC (17%) and M (20%). > 85% of surgeons follow asymptomatic patients for >12 months before release, with many observing >60-month periods for BCC (29%), SCC (36%), SebC (57%), M (68%), and KAC (23%). 92% of respondents defer CDCR; the majority wait >12 months for all tumors before CDCR. A majority (53%) reported at least 75% of patients developing symptomatic epiphora requiring CDCR. The majority of surgeons (73%) do not perform ancillary testing before CDCR, and 53% perform pre-operative imaging. However, 14% have experienced local or orbital tumor recurrence following CDCR. Conclusions: SebC and M follow-up intervals trend shorter, while most respondents follow these tumors post-excision > 5 years. > 25% of surgeons follow all tumors for > 60 months. CDCR is delayed for > 12 months by > 75% of surgeons for all tumors. 8% perform CDCR at the time of excision, and 14% reported local/orbital recurrence following CDCR with 52% obtaining pre-CDCR imaging. These results support extended follow-up before CDCR combined with appropriate imaging/ testing to minimize morbidity/mortality.