Surgical risk factors for recurrence of inverted papilloma

Abstract

Objectives/Hypothesis: To identify variations in surgical technique that impact the recurrence of inverted papilloma following endoscopic excision.Study Design: Retrospective cohort. Methods: Data from 127 consecutive patients who underwent endoscopic excision of inverted papilloma and oncocytic papilloma at a tertiary care medical center from 1998 to 2011 were reviewed. Patient demographics, comorbidities, tumor stage, and intraoperative details, including tumor location and management of the base, were evaluated to identify factors associated with tumor recurrence.Results: Recurrence of papilloma occurred in 16 patients (12.6%). Mean time to recurrence was 31.0 months (range, 5.2-110.0 months). Mucosal stripping alone was associated with a recurrence rate of 52.2% (12/23 patients), compared to 4.9% (3/61 patients) when the tumor base was drilled, 4.7% (1/21 patients) when it was cauterized, and 0.0% (0/22 patients) when it was completely excised (P 5 .001). Increased recurrence rate was associated with tumors located in the maxillary sinus (P 5 .03), as well as the performance of endoscopic medial maxillectomy (P 5 .001) and external frontal approaches (P 5 .02).Conclusions: Drilling, cauterizing, or completely excising the bone underlying the tumor base during endoscopic resection reduces the recurrence rate of inverted and oncocytic papilloma, when compared to mucosal stripping alone. Surgeons who perform endoscopic resection of these tumors should consider utilization of these techniques when possible.

Intranasal endoscopic prelacrimal recess approach for maxillary sinus inverted papilloma

“…During surgery, the tumor tissue and surrounding mucosa should be removed together for the better prevention of postoperative recurrence. The bone hyperplasia in the basal part of the tumor needs to be removed with a bone chisel or drill [16]. The occurrence of adverse reactions must be avoided during surgery [17].…”

A sinonasal inverted papilloma: an evaluation of 38 cases at a single center

“…[11] Kronik enf lamasyon, sigara, [13] Nüks, ilk tedaviden sonra, çoğunlukla aynı yerleşim yerinde, ortalama 31 ayda ortaya çıkmaktadır. [14] Cerrahi tedavinin şekli ile nüks oranları yakından ilişkilidir. Ortalama nüks oranı %25.3 olmakla birlikte, en yüksek nüks oranı (%50) non-endoskopik endonazal yaklaşım uygulanan olgularda görülürken en düşük nüks (%10) endoskopik ve açık cerrahinin kombine uygulandığı olgularda görülmektedir.…”

“…[13] Ayrıca artmış Ki-67 proliferasyon indeksi, bazal hücrelerde sitokeratin 14 ekspresyon kaybı, artmış prolifere edici hücre nükleer antijeni ekspresyonu da nüks riskinin yüksek olduğunu gösterebilir. [14] İnverted papillom ile ilişkili kanser azalan sıklıkta SHK, verrüköz karsinom ve adenokarsinom ile olmaktadır. Hastalarımızın %10.5'inde malignite gelişmiş olup tümü SHK idi.…”

Is radical surgery of an inverted papilloma of the maxillary sinus obsolete? a case report

“…If a tumor is detected at an early stage and in an accessible location, endonasal micro-endoscopic surgery is a very elegant solution and can be done by any accordingly trained surgeon, mostly an otorhinolaryngologist. To achieve low recurrence rates of IP (and oncocytic papilloma), surgeons performing an endoscopic approach should consider drilling, cauterizing, or completely excising the bone underlying the tumor base instead of mucosal stripping alone [7]. Whenever the location or stage of the tumor prohibits the endonasal technique, radical resection is the best option and it does not necessarily cause significant functional and aesthetic problems for the patient.…”