Multiple-factors Analysis Of The Clinical Efficacy And Recurrence Of Nasal Inverted Papilloma After Nasal Endoscopic Surgery

Objective: The effects of Krouse stage,surgical method,previous times of nasal surgery,primary site of tumor(roots or attachment sites)and pathological malignant change on the recurrence rate of nasal inverted papilloma(NIP)patients after nasal endoscopic surgery were analyzed,so as to summarize clinical experience,guide clinical treatment,avoid risk factors and reduce the recurrence rate.Methods:The clinical data of 150 patients with inverted papilloma of the nose treated by nasal endoscopic surgery from December 2009 to September 2017 in the first affiliated hospital of Dalian medical university were retrospectively collected,Furthermore,the correlation between Krouse stage,surgical method(simple nasal endoscopic surgery endoscopic nasal surgery combined with Caldwell-Luc surgical operation and nasal endoscopic combined anterior lacrimal recess operation),previous times of nasal surgery,primary site of tumor(roots or attachment sites)and pathological lesion and postoperative recurrence rate was analyzed.Use the SPSS software to do the statistical analysis for all the result data.Results:1.Among the 150 patients with nasal inverted papilloma,22 relapsed,including16 males and 6 females.Recurrence rate: 14.67%.2.According to the staging group of Krouse,grade T1:18 cases(12%),and 1 case of recurrence;T2 level: 76 cases(50.67%),10 cases of recurrence;T3 level: 49 cases(32.67%),8 cases of recurrence;T4 level: 7 cases(4.67%),3 cases of recurrence.The recurrence rates were 5.55%,13.16%,16.33% and 42.86%,respectively.The recurrencerate in NIP patients at Krouse T4 was significantly higher than that of the other three grades.3.Surgical procedure: 134 cases(89.33%)were performed by simple nasal endoscopic surgery,including 18 cases of recurrence.There were 8 cases(5.33%)of nasal endoscopy combined with Caldwell-Luc operation,and 3 cases of recurrence.There were 8 cases(5.33%)of nasal endoscopic surgery combined with anterior lacrimal recess,and 1 case of recurrence,with recurrence rates of 13.43%,37.50% and 12.5%,respectively.The postoperative recurrence rate of the anterior lacrimal recess approach was the lowest.4.Primary site of tumor: 71 cases(47.33%)of the primary site of tumor were found in the lateral wall of the nasal cavity,followed by 22 cases(14.67%)of the ethmoid sinus and 21 cases(14%)of the medial wall of the maxillary sinus.The primary sites with a high recurrence rate were: bottom wall of the maxillary sinus(66.67%),frontal sinus(33.33%)and medial wall of the maxillary sinus(33.33%).5.Carcinogenesis: 5 cases of inverted papilloma were locally accompanied by squamous cell carcinoma in situ,of which 3 cases relapsed with a recurrence rate of60%.6.Previous times of nasal surgery: 107 cases(71.33%)had no history of surgery,and 12 cases had recurred.There were 28 cases(18.67%)and 3 cases of recurrence.Thirteen patients(8.67%)had surgery twice,and 6 patients had recurrence.Two patients(1.33%)had more than 3 operations,and one patient had recurrence.The recurrence rates were 11.21%,10.71%,46.15% and 50.0% respectively.7.There was no statistical difference between the operative method(P= 0.172),Krouse stage(P=0.117)and recurrence rate,P > 0.05.Tumor origin(P=0.012),previous surgical times(P=0.003),carcinogenesis(P=0.023 by Fisher's exact test)and recurrence rate were statistically different(P<0.05).Conclusion:1.There was no significant correlation between surgical method,Krouse stage and recurrence.Primary site of tumor,previous nasal surgery times and pathologic carcinogenesis were risk factors for recurrence.2.In the treatment of maxillary sinus lesions,the anterior lacrimal recess approach is preferred;Anterior lacrimal recess approach is flexible,less trauma,less postoperative complications and low recurrence rate,which has incomparable advantages over other surgical methods.3.The primary sites of the tumor were located in the anterior medial wall and basilar wall of the maxillary sinus,and the frontal sinus was a risk factor for recurrence.The key to prevent and treat recurrence was whether the root pedicle of the tumor could be clearly exposed and completely removed.Among them,the exposure of the tumor root pedicle is the core step.4.Grasp the advantages provided by the first operation.The success of the first operation will greatly reduce the recurrence rate.5.The prognosis of NIP patients with pathological malignancy is poor and the recurrence rate is extremely high.In short,the recurrence of tumor is multifactorial,which is mutually causal and interlocking.When dealing with risk factors,be holistic.