David Y Healy1, Nipun Chhabra2, Ralph Metson3,4, Eric H Holbrook3,4, Stacey T Gray3,4. 1. Department of Otolaryngology, Naval Medical Center Portsmouth, Portsmouth, Virginia. 2. Department of Surgery, University of Illinois College of Medicine, Saint Anthony Medical Center, Rockford, Illinois. 3. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts. 4. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
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 = .001). Increased recurrence rate was associated with tumors located in the maxillary sinus (P = .03), as well as the performance of endoscopic medial maxillectomy (P = .001) and external frontal approaches (P = .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. LEVEL OF EVIDENCE: 4.
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 = .001). Increased recurrence rate was associated with tumors located in the maxillary sinus (P = .03), as well as the performance of endoscopic medial maxillectomy (P = .001) and external frontal approaches (P = .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. LEVEL OF EVIDENCE: 4.
Authors: Franklin Mariño-Sánchez; Gonzalo de Los Santos; Ana Giribet; Alejandra Aguirre; Javier Alonso; Daniel L Wansley; Ignacio Cobeta Journal: Indian J Otolaryngol Head Neck Surg Date: 2018-03-16
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