The Role of Endoscopic Assistance in Surgery for Pediatric Cholesteatoma in Reducing Residual and Recurrent Disease

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Surgical Oncology

Background:

• Acquired cholesteatoma in children poses challenges for complete eradication.
• Long-term outcomes vary significantly based on surgical technique.
• Understanding recurrence and residual disease patterns is crucial for optimizing pediatric cholesteatoma management.

Purpose of the Study:

• To evaluate long-term recurrent and residual disease after pediatric acquired cholesteatoma surgery.
• To compare outcomes across different surgical approaches: canal wall-up tympanomastoidectomy (CWUT), transcanal exclusive endoscopic approach (TEEA), and canal wall-down tympanomastoidectomy (CWDT).
• To assess the impact of endoscopic assistance on surgical outcomes.

Main Methods:

• Retrospective analysis of 71 interventions in 67 pediatric patients.
• Surgical approaches included CWUT (with/without endoscopy), TEEA, and CWDT.
• Kaplan-Meier method used to estimate long-term disease relapse, recurrence, and residual rates.

Main Results:

• Overall 12-year cholesteatoma relapse rate was 47±6%, with recurrence at 28±6% and residual disease at 26±5%.
• Relapse rates varied by approach: CWDT (33±11%), CWUT (60±9%), TEEA (40±11%). Recurrence rates were CWDT (0%), CWUT (42±9%), TEEA (32±11%).
• Endoscopic assistance significantly reduced residual disease (9±5% with vs. 42±8% without), but did not impact recurrence rates.

Conclusions:

• CWDT remains a viable option for extensive cholesteatomas.
• TEEA is recommended for smaller cholesteatomas to minimize morbidity.
• Endoscopic assistance is beneficial for reducing residual disease in CWUT, aiding complete cholesteatoma removal in pediatric patients.