[Management of sinonasal inverted papilloma: endoscopic excision vs traditional procedures].

Objective To evaluate the effect of endoscopic resection and traditional procedure in the management of sinonasal inverted papilloma with a staging system based on endoscopic examination of the nasal cavity and computed tomography (CT) scan evaluation. Methods Two hundred and twenty-two patients with sinonasal inverted papilloma treated surgically were retrospectively reviewed. There were 23 cases in stageⅠ; 119 cases in stageⅡ;65 cases in stageⅢ and 15 cases in stage Ⅳ. Among these patients, 122 cases were treated endoscopically; 100 cases were treated by traditional surgical techniques,including 56 cases with lateral rhinotomy; 27 cases with intranasal approach and 15 cases with Caldwell-Luc technique. Results The inverted papilloma was removed completely and no serious complications were encountered by all four kinds of techniques used. With an average follow-up of 3.8 years, the recurrence rate for endoscopic group was 14.8%(18/122,four patients were in group Ⅰ; nine in group Ⅱ; four in group Ⅲ; and one patient in group Ⅳ. No recurrence was found in group Ⅲ who underwent endoscopic excision combined with Caldwell-Luc procedure. The recurrence rate for lateral rhinotomy group was 33.9% (19/56, one patients in group Ⅰ; six in group Ⅱ; nine in group Ⅲ; three in group Ⅳ). The recurrence rate for intranasal approach group was 51.9% (14/27,two patients were in group Ⅰ; ten in group Ⅱ; and two in group Ⅲ). The recurrence rate for Caldwell-Luc procedure group was 29.4% (5/17,all in groupⅡ and group Ⅲ). Regardless of approaches, patients who had primary resection had a recurrence of 26.8%, whereas those with secondary resection had a recurrence of 20.9% (P=0.39). Conclusions The endoscopic surgical technique was proved to be a better method for treating sinonasal inverted papilloma in stage Ⅰand stageⅡ. Better results for patients in stage Ⅲ would be achieved by combining endoscopic technique with Caldwell-Luc procedure. As to patients with stage Ⅳ, radical external approache should be considered.