Limitations and complications of endoscopic surgery for treatment for sinonasal inverted papilloma: A reassessment after 212 cases

Abstract

Background. The purpose of this study was to define the optimal surgical strategy for sinonasal inverted papilloma in relation to the site of origin and tumor extent.Methods. Retrospective analysis of patients affected by inverted papilloma treated by purely endoscopic or combined approaches at the Department of Otorhinolaryngology of the University of Brescia and Pavia-Varese from November 1991 to December 2007.Results. Two hundred twelve patients were considered eligible for this study. An exclusive endoscopic approach was performed in 198 patients (93.4%); the remaining 14 patients (6.6%) underwent an endoscopic approach combined with an osteoplastic frontal flap. Follow-up ranged from 24 to 192 months (mean, 53.8 months). A single recurrence was observed in 12 patients (5.7%). Twenty complications (9.4%) were observed.Conclusion. Endoscopic surgery is the first choice in the treatment of inverted papilloma; only lesions with extensive involvement of frontal sinus and/or supraorbital cell may require a combined approach. A minimum follow-up of 5 years is recommended.

Papilomas invertidos nasosinusales: Revisión de 10 años

“…En nuestro estudio el sexo, edad media, síntomas y localización más frecuente del PI se correlaciona con la gran mayoría de la literatura revisada [1][2][3][4][8][9][10][11] . Históricamente fue propuesta la cirugía y radioterapia coadyuvante pero debido a las altas tasas de efectos adversos se desestimó esta última 5 , pudiendo afirmarse actualmente que el abordaje endoscópico exclusivo o combinado externamente ha probado ser eficiente al disminuir las tasas de recurrencia comparado con sólo el tradicional abordaje externo 2,6,9,11 .…”

“…Nuestra tasa de recidivas está probablemente en relación a la extensión, multifocalidad y al empleo en los primeros años de abordaje externo, ya que al resecarse sólo endoscópicamente se equipara con otras publicaciones [1][2][3]10 .Nuestros resultados en cuanto a recidivas se corresponden con los encontrados en la literatura nacional 1,2,4,10 e internacional 8,9,11,12 ; donde el tratamiento quirúrgico endoscópico es de elección sin descartar el abordaje externo cuando la extensión de la tumoración rebase los límites asequibles endoscópicamente. Por su tendencia acusada a recidivar, se recomienda un seguimiento anual endoscópico y, pruebas de imagen sólo si observamos hallazgos patológicos en la exploración endoscópica.…”

An unusual sinonasal inverted papilloma originating from superior turbinate and extending to epiglottis

“…Transforming to a malignant tumor was reported in 5-15% of the cases in the literature. [5] Our patient was a 61-year-old male, and did not have any residual or recurrent tumors in early postoperative period.…”

“…Rhinorrhea, epistaxis, and headache are other frequent symptoms. [4,5] A review of the English literature on PubMED, using the search terms "Sinonasal papilloma" "Schneiderian papilloma" "inverted papilloma" revealed only two cases wherein the tumor extended to the oropharynx and caused dysphagia and hoarseness. [6,7] First complaint of our patient was unilateral nasal obstruction, then dysphagia and sensation of a lump in the throat appeared as the mass got bigger, and extended down to epiglottis.…”

Advances in recurrence and malignant transformation of sinonasal inverted papillomas

“…Although endoscopic sinus surgery (ESS) has been considered the treatment of choice for the majority of SIP cases, surgical decisions should take into account the extent, volume, and lesion location (24). A study of 212 SIP patients demonstrated that SIP lesions with an extensive involvement of the frontal sinus and/or supraorbital cell may require a combined approach (25). In addition, the Korean multicenter study suggested that surgeons should consider combined approaches to reduce recurrence for advanced SIP [Krouse staging system: T3 stage (12); Furuta staging system: T3-A stage (13); Cannady staging system: group B (14)], particularly for novice surgeons (2).…”