External versus endoscopic approach in the management of 131 sinonasal inverted papillomas

Incidence of inverted Papilloma (IP) is around 0.5% to 4% of all nasal tumours. It is characterised by its propensy for local invasiveness, recurrence and malignant transformation. The treatment of reference is surgery. The aim of our study was to compare our oncologic outcome and morbidity between the open and the endoscopic approach to remove inverted papillomas.

This retrospective study includes all primary and benign cases operated between 1985 and 2012. We assessed epidemiologic data, medical history, tumour location, morbidity of treatment, pathological outcomes, patient's follow-up and rate of recurrence. The mean time of surgery, of follow-up and recurrence delay were compared.

131 patients were included: 77 operated by lateral rhinotomy or mid-facial degloving and 54 by endoscopic approach (± associated with a limited Caldwell-Luc or a frontal incision). The mean time of surgery for the endoscopic approach was 76 ± 46 min (10-240 min) vs 163 ± 46 min (60-300 min) for the open approach (p< 10(-5)). The uncinate process was included in most of the IP (97/131; 74%), including its horizontal and/or vertical parts. The mean follow-up in endoscopic group was 43 ± 32 months (12-177 months) vs 73 ± 48 months (12-221 months) for the open approach group (p< 10(-4)). The recurrence rates are not significantly different for both groups: 9% (7/77) after open approach vs 7.4% (4/54) after endoscopic approach (p> 0.05). Also, the mean delay of recurrence was not different between both group (p> 0.05) and the propensy of recurrence didn't depend on the degree of dysplasia. There were fewer complications in the endoscopic group (13%) than in the open approach group (57%).

According to several authors we found no statistical difference on the oncological outcome between surgery via open versus endoscopic approach to remove IP. Endoscopic surgery offers less complications and morbidity than external approach.