Evolution in the Treatment of Sinonasal Inverted Papilloma: Pedicle-Oriented Endoscopic Surgery

Pagella, Fabio; Pusateri, Alessandro; Giourgos, Georgios; Tinelli, Carmine; Matti, Elina

doi:10.2500/ajra.2014.28.3985

Cited by 44 publications

(54 citation statements)

References 33 publications

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“…Bulky disease is cleared with a microdebrider to improve identification of the exact site of attachment(s). The exophytic portion of the tumor is debulked, and when possible the pedicle is excised en bloc with a surrounding margin of mucosa with a technique described by Pagella et al Frozen sections are used to confirm the complete tumor resection. The area of attachment is then gently drilled with a diamond burr.…”

Section: Methodsmentioning

confidence: 99%

“…Busquets and Hwang reported a 12% rate of tumor recurrence after endoscopic resection of IP, compared to a 20% recurrence rate with traditional open approaches. This success may be attributed to a number of factors, including a better understanding of the tumor, improved endoscopic instrumentation, use of computer‐assisted surgical navigation, and the importance of identifying the specific site of tumor attachment and obtaining clear margins …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Inverted papilloma of the sphenoid sinus: Risk factors for disease recurrence

Suh

Ramakrishnan²,

Thompson

et al. 2014

The Laryngoscope

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Inverted papilloma of the sphenoid sinus: Risk factors for disease recurrence

Suh

Ramakrishnan²,

Thompson

et al. 2014

The Laryngoscope

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“…Despite these technological advances, recurrent disease and potential for malignant degeneration remain a concern for patients. The importance of identifying the specific site of tumor attachment has been highlighted recently, and careful preoperative computed tomography (CT) evaluation has become essential in pedicle‐oriented surgery . Small case series have reported increased recurrence in secondary surgery, and anecdotal evidence suggests multifocal disease to be more prevalent than primary cases .…”

mentioning

confidence: 99%

Inverted papilloma with multifocal attachment is associated with increased recurrence

Tong

Patel

Maina

et al. 2019

Int Forum Allergy Rhinol

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Background: Inverted papilloma (IP) is a benign sinonasal tumor with a well-known propensity to recur, especially at its bony a achment site. Anecdotal evidence suggests lower rate of recurrence in primary resection. We also aimed to evaluate the effect of multifocal vs single focus of a achment in disease control. Methods:This work is a retrospective review of 535 IP resections performed during the period from 2006 to 2016 at a tertiary-care center. Demographic data, tumor location and a achment sites, and follow-up duration data were obtained. Results:Two hundred ten patients were eligible for analysis. The mean age was 57 years, with an average postoperative surveillance of 36.4 months. Patients who had a previous procedure at an outside institution have a recurrence rate of 22.3%, compared with 12.4% for patients who had primary surgery at our institution. The most common site of a achment was maxillary sinus (47.6%), followed by ethmoid sinus (39%). Individual tumor review showed 50% of the patients to have multifocal a achment disease, of which there is a higher prevalence in secondary cases when compared with primary cases (53.7% vs 44.9%). Multiple tumor a achment sites had a significant effect on recurrence (odds ratio, 3.5; 95% confidence interval, 1.6-7.6; p = 0.002). Conclusion:Primary resection and single-focus a achment of inverted papilloma are associated with lower recurrence rates at 3-year follow-up. C 2019 ARS-AAOA, LLC. How to Cite thisArticle: Tong CCL, Patel NN, Maina IW, et al. Inverted papilloma with multifocal a achment is associated with increased recurrence. Int Forum Allergy Rhinol. 2019;9:865-869.S inonasal inverted papilloma (IP) is a benign tumor with a locally aggressive nature, a propensity to recur, and potential for malignant transformation to squamous cell carcinoma. Recurrence rates from the most recent metaanalysis reports 14-21% among all IPs, contingent on surgical approach. 1 Although the etiology of tumor remains

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“…1 Standard surgical therapy entails debulking disease until the site of attachment and obtaining an adequate deep margin (including overlying bone, if any). 2 Although histologically benign, if left alone, IPs have a propensity to undergo malignant transformation, the rate of which is estimated to be between 5 and 15%. 3 …”

mentioning

confidence: 99%

Complete Response of Skull Base Inverted Papilloma to Chemotherapy: Case Report

Kuan

Frederick

Díaz

et al. 2017

Allergy�Rhinol (Providence)

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Background:Inverted papilloma (IP) is the most common benign sinonasal neoplasm. Endoscopic techniques, improved understanding of pathophysiology, and novel surgical approaches have allowed rhinologists to treat IPs more effectively, with surgery being the mainstay of therapy. Frontal sinus IP poses a challenge for surgical therapy due to complex anatomy and potentially difficult surgical access.Objectives:We reported a unique case of a massive frontal sinus IP that presented with intracranial and orbital extension, with near resolution after chemotherapy.Methods:A retrospective case review of a patient with a frontal sinus IP treated at a tertiary academic medical center.Results:A 75-year-old male patient presented with nasal obstruction, purulent nasal discharge, and a growing left supraorbital mass. Endoscopy demonstrated a mass that filled both frontal and ethmoid sinuses, with orbital invasion. There also was substantial erosion of the posterior table, which measured 1.73 × 1.40 cm. A biopsy specimen demonstrated IP with carcinoma in situ. The patient was deemed unresectable on initial evaluation and, subsequently, underwent chemotherapy (carboplatin and paclitaxel). The tumor had a dramatic response to chemotherapy, and the patient elected for definitive surgery to remove any residual disease. During surgery, only a small focus of IP was found along the superior wall of the frontal sinus. No tumor was found elsewhere, including at the site of skull base erosion. The final pathology was IP without carcinoma in situ or dysplasia.Conclusion:This was the first reported case of chemotherapeutic “debulking” of IP, which facilitated surgical resection, despite substantial intracranial and orbital involvement. Although nearly all IPs can be treated surgically, rare cases, such as unresectable tumors, may benefit from systemic chemotherapy.

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Evolution in the Treatment of Sinonasal Inverted Papilloma: Pedicle-Oriented Endoscopic Surgery

Cited by 44 publications

References 33 publications

Inverted papilloma of the sphenoid sinus: Risk factors for disease recurrence

Inverted papilloma of the sphenoid sinus: Risk factors for disease recurrence

Inverted papilloma with multifocal attachment is associated with increased recurrence

Complete Response of Skull Base Inverted Papilloma to Chemotherapy: Case Report

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