Panara Kush, Workman Alan D, Lerner David K, Tong Charles C L, Wilensky Jadyn, Douglas Jennifer E, Adappa Nithin D, Palmer James N, Kohanski Michael A
Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania.
*Current affiliation: Department of Otolaryngology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
Am J Rhinol Allergy. 2025 Mar;39(2):98-101. doi: 10.1177/19458924241305658. Epub 2024 Dec 20.
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%, = .36). Patients with recurrences within 5 years of surgery were more likely to have received frozen sections than those with recurrences beyond 5 years ( < .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%, = .01) and persistent disease following a previous resection at an outside institution (67.0% vs 44.0%, = .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.
为降低内翻性乳头状瘤（IP）的复发率，一些人主张术中采用冰冻切缘；结果不一，且研究严重缺乏长期的随访期。
我们旨在阐明延长随访和术中冰冻切缘对IP复发的影响。
这是一项对2008年至2018年期间在一家三级医疗中心接受IP切除术并随后进行随访的患者的回顾性分析。分析了患者的人口统计学、肿瘤和手术特征以及复发情况。
我们的分析包括199例患者，37例复发，平均复发时间为44.4个月；57%的患者接受了术中冰冻切片检查，接受冰冻切片检查的患者与未接受者的复发率相似（20.1%对15.5%，P = 0.36）。术后5年内复发的患者比5年后复发的患者更有可能接受了冰冻切片检查（P < 0.01）。接受冰冻切缘的患者在手术方式或疾病范围上没有差异。接受冰冻切片检查的患者更有可能有多个附着部位（56.5%对38.1%，P = 0.01）以及在外部机构先前切除术后有持续性疾病（67.0%对44.0%，P = 0.001）。
我们的平均复发时间为44.4个月，明显长于文献报道的随访时间，表明需要更长时间的随访来发现晚期复发。我们的分析是首个以标准化方式研究IP切除术的美国大型队列研究，发现接受或未接受冰冻切片检查的患者复发率相似。
