A Systematic Review of Definitive Treatment for Inverted Papilloma Attachment Site and Associations With Recurrence

Abstract

Objective Inverted papilloma (IP) is the most common benign neoplasm of the nasal cavity with known risk of recurrence. There is no standardized approach to definitive treatment for attachment sites. This systematic review aims to determine whether surgeon choice of technique differs by anatomic attachment site and whether different surgical techniques contribute to reduced rates of recurrence. Data Sources PubMed and Ovid Medline. Review Methods A systematic review was conducted for studies reporting on IP. Those that included IP recurrence rates and primary tumor attachment site were reviewed. Results Of 122 published studies, 14 met eligibility criteria, representing 585 patients and a recurrence rate of 5.8%. The maxillary sinus (50.9%) was the most common primary attachment site, and the sphenoid sinus was associated with the highest rate of recurrence (10.4%). The most utilized technique included debulking the tumor, removing mucosa over the attachment site, and drilling the underlying bone. The most common Krouse stage represented was T3 (53.3%). No single technique predicted a propensity for recurrence, but certain techniques are favored depending on IP attachment site. Finally, frozen sections to obtain evidence of clear margins intraoperatively significantly reduced rates of recurrence (3.4% vs 7.3%, P = .045). Conclusion Based on the current literature, the most common technique to address site of attachment involves resecting mucosa and drilling the tumor base. Choice of technique appears to differ for various sites of attachment. Use of intraoperative frozen section analysis appears to be associated with decreased recurrence overall. Level of Evidence 3.

Eficacia del tratamiento quirúrgico del papiloma invertido nasosinusal

“…Tras conocer en nuestro estudio el hallazgo de PI, ya sea mediante biopsia en consulta o como hallazgo incidental tras una CENS por posible poliposis, en la mayoría de ellos se planteó intervención curativa mediante maxilectomía medial. Trent et al [17] recomiendan el fresado del hueso subyacente tras la realización de maxilectomía medial para la resección del PI. En nuestro estudio, no se asoció esta técnica, obteniendo aún así bajas tasas de recurrencia y persistencia.…”

“…La ubicación en el seno frontal es más susceptible de necesitar abordajes combinados debido a la complejidad en el acceso a la lesión, sobre todo si se localiza en la pared lateral. Habitualmente en estos casos es necesario realizar una osteoplastia frontal además de un abordaje endoscópico mediante Draf III [2,[13][14][15][16][17]. Si la patología se extiende de forma extrasinusal o presenta malignización carcinomatosa, puede estar indicado un abordaje externo más agresivo [2,7,11,[18][19][20].…”

“…La mayoría de las recurrencias se dan en los primeros 24 meses de seguimiento, siendo infrecuentes más allá de los 5 primeros años [6,16,22]. Por esto, aunque determinadas series afirman que es recomendable seguir de por vida a estos pacientes [3,20], consideramos que cinco años de seguimiento podrían ser adecuados [8,11,12,17,18].…”

The choice of endoscopic surgical approach and four steps of operation of inverted papilloma of the maxillary sinus

“…Sinonasal inverted papilloma (IP) is a benign tumor and constitutes about 0.5–4% of the sinonasal region tumors [ 1 ]. The distribution of attachment sites in patients with sinonasal papilloma has changed as the endoscope has enabled more detailed identification of pedicle attachment in recent years [ 2 ], the most common site of attachment was maxillary sinus (MS), followed by ethmoid sinus, frontal sinus and sphenoid sinus [ 1 – 3 ], the origin is 42–59% in MS [ 1 , 2 , 4 ]. IP can be locally aggressive; it has both the ability to recur after removal and carries a risk of converting into a malignant squamous cell carcinoma.…”

“…IP can be locally aggressive; it has both the ability to recur after removal and carries a risk of converting into a malignant squamous cell carcinoma. For these reasons, the goal of surgical treatment is to completely remove the lesion by direct, visual surgery and to reduce the morbidity rate of this treatment [ 1 , 5 ].The traditional external surgical approach of lateral rhinotomy with medial maxillectomy has given way to transnasal endoscopic resection. However, for anatomical reasons, the positions of the anterior and medial walls and the alveolar crypt of MS are not easily visible and manageable, therefore, it is difficult to perform complete resection using the traditional endoscopic middle meatal antrostomy (MMA) [ 6 , 7 ].…”