The comparison of endoscopic and external surgical approaches for sinonasal inverted papilloma and their impact on tumour recurrence

Abstract

Introduction: Sinonasal inverted papilloma (SNIP) is a rare, benign tumour originating from the mucosal lining of the sinonasal cavity. The treatment is aimed at complete tumour resection. Current resection methods include external excision, endoscopic surgery and a combined approach. The high rate of SNIP recurrence poses a challenge for the ear nose and throat (ENT) specialist. There is a debate about which method provides the best outcomes. In this study, the most recent literature is analysed to evaluate the effectiveness of each surgical approach in terms of recurrence rate and surgical complications.
 Results: The literature search yielded data for 941 patients from ten studies. The analysis showed a recurrence rate of 13.5% for the endoscopic approach, 34% for combined and 36.7% for the external. The lowest recurrence rate (0%-3.6%) was reported when novel endoscopic approaches, such as prelacrimal recess or ‘TuNa’ saving, were used. However, the comparison of surgical complications was challenging due to inconsistent reporting.
 Discussion: The external approach previously considered a ‘gold standard’ is now becoming replaced by endoscopic surgery. The advantages of an endoscopic approach are a lower recurrence rate, better visualisation of the tumour and a more precise excision. Moreover, this approach preserves the surrounding tissues, reducing the amount of complications and recovery time. However, the external approach should still be employed when SNIP is widespread or in proximity with vital structures. Careful pre-operative planning is needed as the primary surgery has the best chances of eliminating the disease. Each revision surgery subsequently increases the risk of SNIP recurrence. Furthermore, there is a need for agreement on minimal surveillance time after SNIP resection.
 Conclusion: The endoscopic approach should be a mainstay of SNIP treatment due to low recurrence rate and better patient outcomes. Nevertheless, ENT specialists should keep in mind that for more advanced disease, external an combined methods may be more appropriate.