TY - JOUR
T1 - Challenges in the management of inverted papilloma
T2 - A review of 72 revision cases
AU - Adriaensen, Gwijde F.J.P.M.
AU - Lim, Keng Hua
AU - Georgalas, Christos
AU - Reinartz, Susanne M.
AU - Fokkens, Wytske J.
N1 - Publisher Copyright:
© 2015 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Objectives/Hypothesis We report on the treatment outcome of endoscopically managed sinonasal inverted papilloma, focusing on revision cases. Our aim was to identify the properties of revision cases that affect treatment outcome by comparing them to primary cases in a single center. We propose using 5-fluorouracil (5-FU) in the postoperative management of inverted papilloma. Study Design A retrospective single-center case series. This study met the criteria for approval by the local medical ethics committee. Methods We performed a retrospective chart review identifying patients operated on between January 2003 and September 2013. Data were collected about patient demographics, symptoms, tumor attachment site, imaging, intraoperative and pathological findings, surgical approaches, postoperative treatment, follow-up, and recurrence. Results One hundred and twenty-one (72 revision and 49 primary) cases were retrieved with a minimum follow-up of 1 year. Revision cases have significantly higher Krouse staging (P = 0.003), different distribution of tumor attachment sites, and higher recurrence rates. The recurrence rate was 4.1% for primary cases (mean follow-up 35.5 months) and 18.1% for revision cases (mean follow-up 45 months). Eight of the recurrent cases recurred within the first year. 5-fluorouracil was applied postoperatively in 18 (5 primary and 13 revision) cases, which included one (5.6%) recurrence and one minor complication (transient periorbital swelling). Conclusion The most important factors in preventing the recurrence of inverted papilloma are the determination of the location of the attachment and the completeness of resection in the primary endoscopic surgery. Revision cases have a higher recurrence rate, and the attachment sites are surgically more challenging. The use of 5-FU might have a place in the postoperative treatment of surgically challenging inverted papilloma. Level of Evidence 4. Laryngoscope, 126:322-328, 2016.
AB - Objectives/Hypothesis We report on the treatment outcome of endoscopically managed sinonasal inverted papilloma, focusing on revision cases. Our aim was to identify the properties of revision cases that affect treatment outcome by comparing them to primary cases in a single center. We propose using 5-fluorouracil (5-FU) in the postoperative management of inverted papilloma. Study Design A retrospective single-center case series. This study met the criteria for approval by the local medical ethics committee. Methods We performed a retrospective chart review identifying patients operated on between January 2003 and September 2013. Data were collected about patient demographics, symptoms, tumor attachment site, imaging, intraoperative and pathological findings, surgical approaches, postoperative treatment, follow-up, and recurrence. Results One hundred and twenty-one (72 revision and 49 primary) cases were retrieved with a minimum follow-up of 1 year. Revision cases have significantly higher Krouse staging (P = 0.003), different distribution of tumor attachment sites, and higher recurrence rates. The recurrence rate was 4.1% for primary cases (mean follow-up 35.5 months) and 18.1% for revision cases (mean follow-up 45 months). Eight of the recurrent cases recurred within the first year. 5-fluorouracil was applied postoperatively in 18 (5 primary and 13 revision) cases, which included one (5.6%) recurrence and one minor complication (transient periorbital swelling). Conclusion The most important factors in preventing the recurrence of inverted papilloma are the determination of the location of the attachment and the completeness of resection in the primary endoscopic surgery. Revision cases have a higher recurrence rate, and the attachment sites are surgically more challenging. The use of 5-FU might have a place in the postoperative treatment of surgically challenging inverted papilloma. Level of Evidence 4. Laryngoscope, 126:322-328, 2016.
KW - 5-fluorouracil
KW - endoscopic sinus surgery
KW - Inverted papilloma
KW - recurrence
KW - revision
UR - https://www.scopus.com/pages/publications/84973421631
U2 - 10.1002/lary.25522
DO - 10.1002/lary.25522
M3 - Article
C2 - 26344930
AN - SCOPUS:84973421631
SN - 0023-852X
VL - 126
SP - 322
EP - 328
JO - Laryngoscope
JF - Laryngoscope
IS - 2
ER -