Challenges in the Management of Inverted Papilloma: A Review of 72 Revision Cases.
OBJECTIVE
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.


METHODS
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).


CONCLUSIONS
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.


METHODS
4.
Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.
Gwijde F J P M
GF
Adriaensen
Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore.
Keng-Hua
KH
Lim
Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.
Christos
C
Georgalas
Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.
Susanne M
SM
Reinartz
Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.
Wytske J
WJ
Fokkens
D019468:Disease Management; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D018308:Papilloma, Inverted / Q000188:drug therapy / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D005472:Fluorouracil
5-fluorouracil; Inverted papilloma; endoscopic sinus surgery; recurrence; revision