Endoscopic resection of sinonasal inverted papilloma: a meta-analysis.

OBJECTIVES: Endoscopic resection has become an increasingly popular method of treating sinonasal inverted papillomas. The literature on endoscopic approaches to inverted papilloma consists primarily of relatively small case series (grade C evidence). This study aims to systematically review and integrate the available literature to objectively compare success rates of endoscopic versus nonendoscopic tumor resection techniques.

STUDY DESIGN: A systematic review of the literature on resection of inverted papillomas.

METHODS: Comprehensive review of the English-language literature on resection of inverted papillomas was performed. The reports were subdivided into endoscopic approaches versus nonendoscopic approaches, applying strict inclusion and exclusion criteria. Our institution's experience with endoscopic treatment of inverted papilloma was also included. Studies from the era of endoscopic sinus surgery (1992-2004) formed a "contemporary" cohort and were compared with a "historical" cohort developed from the literature between 1970 and 1995.

RESULTS: Thirty-two studies were included in the contemporary cohort, comprising 714 patients treated endoscopically and 346 patients treated nonendoscopically. Thirteen studies in the historical cohort yielded 692 patients treated nonendoscopically. There was a significantly lower recurrence rate in the contemporary cohort compared with the historical cohort (15% v 20%, P = 0.02). Within the contemporary cohort, endoscopically treated patients had significantly lower recurrences than nonendoscopically treated patients (12% v 20%, P < 0.01). Notably, the recurrence rate for nonendoscopically treated patients in the contemporary cohort was equivalent to that of the nonendoscopic patients in the historical cohort (20% v 19%, P = 0.78).

CONCLUSIONS: A systematic review of the literature supports endoscopic resection as a favorable treatment option for most cases of sinonasal inverted papilloma.

EBM RATING: B-3a.