Key results
Our patient cohort demographics were similar to other studies, with an observed 2:1 male-to-female ratio and average age of presentation of 62.8 years. As in previous research, the maxillary sinus was the most common site for primary IPs. (5) In literature, primary and secondary cases have recurrence rates of 10% and 29% respectively (5,6), which is comparable to our cohort’s recurrence rates of 15% (6/40) and 37.5% (15/40) for our primary and secondary cases.
The mean time of recurrence was 20 and 39 months for primary and secondary cases, which is different to what has been found in previous literature. (5) This difference could be explained by the faster detection rate and the significantly smaller number of recurrences in primary cases seen in our cohort (16% vs 84%), highlighting that outcomes and recurrence rates for IP are better when managed by a fellowship-trained rhinologist.
As in previous literature, patients with Krouse stage 3 cases and IPs located in the frontal and maxillary sinuses had the highest rates of recurrences. (5,6) This may be explained by the technical difficulty of accessing the frontal sinus, limited visualisation of the tumour via endoscopy, and the challenge of obtaining a margin when up against critical structures. (8) Similarly, maxillary IPs are associated with increased recurrence rates in literature; (6) due to the challenging visualisation and access of the site (2,6), especially the floor of the antrum and medial maxillary wall.
The worse outcomes seen in secondary cases may be explained by the absence of landmarks due to previous dissections, scarring and distorted anatomy. (9) However, our cohort further highlights that IPs have a lower rate of recurrences when managed by a fellowship-trained rhinologist. Thus, figure 2 contains the suggested gold-standard treatment pathway for all sinonasal tumours.