Prolonged Surveillance in Inverted Papilloma Reveals Delayed Recurrence and Lack of Benefit to Frozen Section

To reduce recurrence rates of inverted papilloma (IP), some have argued for the use of intraoperative frozen margins; results remain mixed and studies critically lack lengthy surveillance periods.

We aim to elucidate the impact of prolonged surveillance and intraoperative frozen margins on IP recurrence.

This is a retrospective analysis of patients who underwent resection of IP at a tertiary care center over a 10-year period from 2008 to 2018 followed by subsequent surveillance. Patient demographics, tumor and operative characteristics, and recurrences were analyzed.

Our analysis includes 199 patients, with 37 recurrences and an average recurrence time of 44.4 months; 57% of patients received intraoperative frozen sections and recurrence rates were similar between those who received frozen sections and those who did not (20.1% vs 15.5%, P = .36). Patients with recurrences within 5 years of surgery were more likely to have received frozen sections than those with recurrences beyond 5 years (P < .01). There was no difference in surgical approach or extent of disease in those who received frozen margins. Patients that received frozen sections were more likely to have multiple sites of attachment (56.5% vs 38.1%, P = .01) and persistent disease following a previous resection at an outside institution (67.0% vs 44.0%, P = .001).

Our average time to recurrence was 44.4 months, significantly longer than surveillance times reported in the literature, indicating that longer periods of surveillance are necessary to capture late recurrences. Our analysis is the first and largest American cohort to look at IP resection in a standardized fashion and find that recurrence rates are similar between patients receiving frozen sections or not.