title: Surgical risk factors for recurrence of inverted papilloma.
abstract: OBJECTIVE
  To identify variations in surgical technique that impact the recurrence of inverted papilloma following endoscopic excision.
  
  
  METHODS
  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.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology, Naval Medical Center Portsmouth, Portsmouth, Virginia.
authors.forename: David Y
authors.initials: DY
authors.lastname: Healy
authors.affiliation: Department of Surgery, University of Illinois College of Medicine, Saint Anthony Medical Center, Rockford, Illinois.
authors.forename: Nipun
authors.initials: N
authors.lastname: Chhabra
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Ralph
authors.initials: R
authors.lastname: Metson
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Holbrook
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.|Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Stacey T
authors.initials: ST
authors.lastname: Gray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D018308:Papilloma, Inverted / Q000453:epidemiology* / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Inverted papilloma; Schneiderian papilloma; endoscopic sinus surgery; paranasal sinus tumor; risk factors