Use of Intraoperative Negative Margins Reduces Inverted Papilloma Recurrence

Miglani, Amar; Hoxworth, Joseph M.; Zarka, Matthew A.; Lal, Devyani

doi:10.2500/ajra.2018.32.4504

Cited by 12 publications

(21 citation statements)

References 13 publications

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“…Typical symptoms at initial presentation comprised nasal obstruction, rhinorrhoea and epistaxis 32 . In line with previous studies, tumor staging revealed Krouse staging T2 and T3 in 81.4% of all cases at initial presentation 5,7,9 . However, a previous reported significant increase in RR from Krouse staging T2 to T3 was not confirmed 5 .…”

Section: Discussionsupporting

confidence: 87%

“…Distinction between persistence as a result of incomplete initial surgery and a true recurrence is a known difficulty in many sinonasal tumors, especially for slow‐growing neoplasms, such as SNIPs. With regard to literature, positive resection margins are widely accepted as risk factors for recurrence 7‐10 . Furthermore, RR in revision surgery is significantly higher compared to primary tumor resections, most likely due to distorted anatomy of the tumor base and absence of landmarks 7 .…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, it was shown that SNIPs classified as stage T3 tumors revealed a 51% higher likelihood of recurrence 5 . While confirmed negative margins are associated with increased recurrence free survival (RFS), frontal sinus involvement, incomplete resection, presence of dysplasia, multifocal attachment and pertinent human papilloma virus (HPV) infection have been implicated as risk factors 7‐14 . Overall, reported recurrence rates (RRs) in the literature vary from 5% to 45% 4,7,15‐17 .…”

Section: Introductionmentioning

confidence: 99%

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Need for long‐term follow‐up in sinonasal inverted papilloma: A Single‐institution experience

et al. 2020

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Background: Most studies on sinonasal inverted papillomas (SNIPs) regarding risk factors for recurrence, recurrence rates (RRs) and malignant transformation are biased by a significant proportion of revision cases. Methods: Retrospective study on patients with consecutive, treatment-naïve SNIPs at a tertiary referral center between 1999 and 2019. Results: Overall, RR was 9.8% (10 of 102 patients), with 2 of 10 recurrences (20%) occurring after more than 5 years. Histopathological workup revealed synchronous malignancy in 2 of 102 patients (2%). Subgroup analysis revealed a significantly higher RR for SNIPs involving the frontal sinus (26.3% vs 6.0%, P = .02). No SNIPs primarily originating from the frontal sinus were observed. Conclusion: Overall, RR of treatment-naïve SNIPs is comparably low; however, long-term follow-up is mandatory due to late recurrences. Secondary involvement of the frontal sinus was identified as risk factor for recurrence. No SNIPs primarily originating from frontal sinus were observed.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Need for long‐term follow‐up in sinonasal inverted papilloma: A Single‐institution experience

et al. 2020

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“…Attachment-oriented resection leads to decreased recurrence rates (<10%) [2,12,16,17,18,21,69,70]. This technique involves subperiosteal tumor resection at the site of tumor origin with a safety margin of 1–1.5 cm [12,15,16,18,38,69]. By using intraoperative negative margins, the recurrence rates can be further reduced [69].…”

Section: Discussionmentioning

confidence: 99%

“…This technique involves subperiosteal tumor resection at the site of tumor origin with a safety margin of 1–1.5 cm [12,15,16,18,38,69]. By using intraoperative negative margins, the recurrence rates can be further reduced [69]. Moreover, there are different recurrence rates, when revision cases are addressed (e.g., 4% vs. 15% recurrence) [60,70,71].…”

Section: Discussionmentioning

confidence: 99%

Surgery of Inverted Papilloma of the Maxillary Sinus via Translacrimal Approach—Long-Term Outcome and Literature Review

Hildenbrand

Weber

Mertens

et al. 2019

JCM

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There are several differential diagnoses of unilateral sinus disease. One of these is inverted papilloma (IP) of the maxillary sinus, which is a common benign tumor with a substantial rate of malignant transformation. In general, endoscopic endonasal techniques for addressing the tumor are favored nowadays instead of classical external approaches. The aim of this retrospective study was to investigate the long-term outcome of inverted papilloma treated endoscopically via the prelacrimal approach. We reviewed 17 patients with primary or recurrent IP of the maxillary sinus that were treated via the prelacrimal endoscopic endonasal technique. After a median follow-up period of 45.9 months (3.8 years), none of the 17 included patients showed signs of recurrent disease and no serious complications were reported. Hypoesthesia of the incisors was reported by four patients and was resolved with time in one. All of the maxillary sinuses could be fully visualized with the flexible endoscope. IP is an important differential diagnosis in the clinical finding of unilateral nasal polypoid lesions. The prelacrimal approach is an effective and safe method in the treatment of IP with limited patient morbidity.

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How aggressive should resection of inverted papilloma be? Refinement of surgical planning based on the 25‐year experience of a single tertiary center

Ferrari

Schreiber

Mattavelli

et al. 2020

Int Forum Allergy Rhinol

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BackgroundThe technique for transnasal endoscopic resection of inverted papilloma (IP) has evolved considerably during the last 20 years. The aim of the present study is to retrospectively analyze a single tertiary center series, with special emphasis on assessing the value of an “insertion‐driven” technique on local control.MethodsPatients undergoing endoscopic resection for IP at the University of Brescia during the period 1991 to 2015 were enrolled. Site of origin and extension of IPs were assessed, together with presence of dysplasia and carcinoma in situ. Patients were divided in 3 cohorts: (1) historical cohort (treated before 2008), (2) contemporary “centripetal” cohort (treated with a traditional technique after 2008), and (3) contemporary “insertion‐driven” cohort (treated with insertion‐driven resection). Groups were compared considering outcomes and complications.ResultsThe series included 210 patients. Mean follow‐up was 77.8 months. Thirty‐eight (18.1%) patients showed precancerous changes. Maxillary involvement (p = 0.021) and presence of precancerous changes (p = 0.013) were significantly associated with a higher risk of recurrence. Five‐year local control rate before and after 2008 was 95.1% and 90.5%, respectively. The insertion‐driven cohort was associated with lower disease control when IPs involved the maxillary sinus. The rate of complications was 11.9%. The insertion‐driven cohort was associated with a lower rate of major complications (p = 0.098).ConclusionPreoperative evidence of precancerous changes and/or involvement of maxillary sinus should prompt the surgeon to address the disease more aggressively (centripetal resection). Preoperative imaging and biopsy with abundant material may optimize the chance to stratify patients eligible for less or more conservative approaches.

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Use of Intraoperative Negative Margins Reduces Inverted Papilloma Recurrence

Cited by 12 publications

References 13 publications

Need for long‐term follow‐up in sinonasal inverted papilloma: A Single‐institution experience

Need for long‐term follow‐up in sinonasal inverted papilloma: A Single‐institution experience

Surgery of Inverted Papilloma of the Maxillary Sinus via Translacrimal Approach—Long-Term Outcome and Literature Review

How aggressive should resection of inverted papilloma be? Refinement of surgical planning based on the 25‐year experience of a single tertiary center

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