Apollo Hospitals Pune Successfully Treats Rare and Locally Advanced Naso-Lacrimal Cancer with Eye Preservation
Pune : A 50-year-old male patient from Satara has been successfully treated at Apollo Hospitals, Pune for an exceptionally rare and locally advanced cancer of the naso-lacrimal apparatus, the drainage system connecting the eye to the nasal cavity. The case, led by Dr. Vidita Powle, Senior Consultant, Head and Neck Surgical Oncologist, involved a high-risk composite resection, including an extended supero medial maxillectomy with eye preservation, along with neck dissection and advanced bi-paddled microvascular free flap reconstruction. The patient was discharged within a week in stable condition with a good functional outcome.
By the time the patient reached Apollo Hospitals, Pune, the tumour was abutting the left eyeball, eroding the lamina papyracea, involving the inferior orbital floor, medial orbital wall, overlying skin, and medial canthus of the left eye, and extending to the cribriform plate. Diagnostic nasal endoscopy further revealed a second synchronous primary tumour on the nasal septum, adding exceptional complexity to an already rare presentation.
Dr. Vidita Powle, Senior Consultant, Head and Neck Surgical Oncology, Apollo Hospitals, Pune, said: “This was a case that tested every dimension of surgical oncology, from diagnosis to reconstruction. What began as a seemingly simple eye complaint masked one of the rarest and most aggressive cancers we encounter . The patient complained of persistent watering from the left eye and swelling near the inner corner of the left eye, for which he underwent a failed dacryocystorhinostomy and definitive chemo radiation elsewhere. He was diagnosed with an extremely rare non-keratinising squamous cell carcinoma of the nasolacrimal duct. Post chemo radiation, the disease recurred within 3 months in a far more aggressive form, presenting to us as a locally advanced infiltrating tumour. The disease involved the left nasolacrimal sac, abutting the eyeball and destroying adjacent skull base structures, along with another lesion along the nasal septum. Our priority was clear: achieve complete oncological clearance without sacrificing the eye and restore the patient’s quality of life through meticulous reconstruction.”
Dr. Manisha Karmarkar, Chief Executive Officer (CEO), Apollo Hospitals, Pune, said: “This case exemplifies what Apollo Hospitals, Pune stands for: the courage to take on what others may not, the clinical depth to succeed where the odds are formidable, and the commitment to return every patient to a life of dignity and the best possible quality. Rare and complex cases like this one demand not just surgical excellence, but a culture of multidisciplinary collaboration, advanced infrastructure, and a relentless focus on the patient at the centre of every decision. We are immensely proud of Dr. Vidita Powle and the entire team for this remarkable achievement, and we remain resolute in our mission to bring the highest standards of oncological care to the people of Pune and beyond.”
A multidisciplinary team led by Dr. Vidita Powle performed a complex surgery to remove the tumour. The procedure included extensive resection, maxillectomy, neck dissection, and advanced reconstruction using a free flap. Despite the tumour being very close to the left eye, the team was able to remove it completely while preserving the eye. The procedure lasted around 8 hours. The patient recovered well and was released after a week in stable condition with good functional outcomes. Such cases, particularly those involving a second cancer in the same location, are exceedingly rare. This instance highlights the need of investigating chronic eye watering or swelling at the inner corner of the eye if it fails to improve with treatment.
