Outcomes of sinonasal inverted papilloma resection by surgical approach: an updated systematic review and meta-analysis

Int Forum Allergy Rhinol. 2019 Jun;9(6):573-581. doi: 10.1002/alr.22305. Epub 2019 Feb 12.


Background: Selecting the optimal surgical approach for resection of sinonasal inverted papilloma (SIP) remains a challenge, with endoscopic, external, and combined approaches being utilized. This systematic review was conducted as an update to a 2006 systematic review to determine the preferred surgical approach for tumor control.

Methods: The study protocol was developed a priori following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process. Data were collected and outcomes were analyzed according to surgical approach and sites of tumor involvement.

Results: A total of 96 papers and 4134 SIP patients were included. The overall recurrence rate was 12.80% (322/2515) for the endoscopic approach group, 16.58% (182/1098) for the external approach group, and 12.60% (65/516) for the combined approach group. Meta-analysis by random effects model showed that the summarized risk ratio (RR) of recurrence was 0.61 (95% confidence interval [CI], 0.44 to 0.85, p = 0.003), I2 = 37.95% for the endoscopic vs external approach; 0.98 (95% CI, 0.69 to 1.39, p = 0.901), I2 = 9.06% for the endoscopic vs combined approach; 1.61 (95% CI, 1.06 to 2.43, p = 0.025), I2 = 0.00% for the external vs combined approach. After adjusting for publication bias, the adjusted RRs were 0.66 (p = 0.014) for endoscopic vs external; 0.99 (p = 0.955) for endoscopic vs combined; and 1.33 (p = 0.224) for external vs combined.

Conclusion: An enlarging and maturing body of literature continues to indicate that endoscopic approaches result in significantly lower recurrence rates than open approaches for surgical resection of SIP.

Keywords: combined approach; endoscopic sinus surgery; inverted papilloma; meta-analysis; open approach; outcomes; recurrence; systematic review.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Humans
  • Natural Orifice Endoscopic Surgery
  • Neoplasm Recurrence, Local / surgery
  • Odds Ratio
  • Otorhinolaryngologic Surgical Procedures
  • Papilloma, Inverted / pathology
  • Papilloma, Inverted / surgery*
  • Paranasal Sinus Neoplasms / pathology
  • Paranasal Sinus Neoplasms / surgery*
  • Reoperation
  • Treatment Outcome