Endoscopic management of inverted papillomas: long-term results--the St. Paul's Sinus Centre experience.

OBJECTIVES To demonstrate that computer-assisted endoscopic management of inverted papillomas yields excellent long-term results in terms of preventing recurrence and minimizing significant morbidity and mortality. METHODS A retrospective chart review of patients who are being followed up for tumour recurrence or have undergone tumour removal between 2000 and 2008. All cases were undertaken using the GE Instatrak 3500+ navigation system. RESULTS Inverted papillomas are the most common tumour managed endoscopically (57% of all sinonasal tumours) with 76 patients seen over the last 8 years. Approximately 50% of these cases had undergone previous surgery in another centre where the tumour was either not recognized or the resection was incomplete. Twentynine percent of these patients had a recurrence but only three required a revision procedure using an open approach; otherwise recurrences were successfully managed endoscopically. Endoscopic recurrence during the first half was 32% (versus 14% for open procedures), dropping to a recurrence rate of 11% in the latter period. CONCLUSIONS Endoscopic management of inverted papillomas allows good control of the disease and avoids unnecessary morbidity associated with open procedures. Although there is a higher initial recurrence rate, these recurrences can be successfully managed endoscopically, and computer navigation can be a useful adjunct in achieving this.