[The Problem of High Recurrence Rate in Endoscopic Revision Surgery for Inverted Papilloma]

Inverted papilloma (IP) is a benign lesion of the sinonasal tract. Clinical problems arise from expansive growth and bone destruction, a possible association with malignancy and a tendency to recur. Complete subperiostal/subperichondral removal via endoscopic sinus surgery (ESS) is the treatment of choice. The purpose of this study was to evaluate the theory of an elevated recurrence rate after secondary resection.

The retrospective analysis comprised 66 patients, who were treated for IP at the University Clinic of Otorhinolaryngology Graz between 2000 and 2011. The mean follow-up was 33.85 months. 18 patients were lost to follow-up.

The study group consisted of 51 males and 15 females. 65 (98.5%) of which had been operated on purely endoscopic or via a combined approach. Recurrence was diagnosed in 14 cases (29.2%), on average 11.9 months after surgery, 71.5% of these in the first 12 months. The recurrence rate was significantly higher after revision surgery (50%) when patients had been previously operated elsewhere as compared to primary resection (12%). The analysis also showed a significant increase in recurrences for Krouse stages 3 and 4.

The collected data confirms ESS as the best treatment option. Due to recurrences and malignant transformation, follow-up should be performed within 5 years postoperatively. We could statistically verify the prognostic value of Krouse's staging system. The elevated recurrence rate after secondary resection emphasises the significance of removing the tumour completely during the first surgery.