Ventajas y desventajas de las cirugias endoscopica y combinadas en el tratamiento del papiloma nasosinusal según la clasificación de krause
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2022
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Introducción: Existe controversia sobre cuál es el enfoque quirúrgico más adecuado frente al papiloma nasal invertido. Una razón puede ser los distintos sitios de implantación del tumor y de su extensión entre los trabajos realizados, todos con muestras pequeñas. Al momento en Ecuador no se ha realizado estudio semejante. Objetivo: Analizar las ventajas y desventajas de las cirugías endoscópicas y combinadas en el tratamiento del papiloma nasosinusal invertido según la clasificación de Krause. Metodología: Cohorte histórica realizada en pacientes atendidos en el hospital de especialidades Teodoro Maldonado Carbo (HTMC) entre el 2011-2020. Resultados: Se recuperó 104 casos, 56/104 (53.8%) cirugía endoscópica y 48/104 (46.2%) combinada, 61/104 (58.7%) eran ≥60 años y 40/104 (38.5%) mujeres. Se estimó un Krouse I, II, III y IV de 24/104 (23.1%), 52/104 (50.0%), 25/104 (24%) y 3/104 (2.9%), respectivamente. Una localización más alejada de la cavidad nasal se asoció con elección de abordaje combinado (OR 1.552; IC 95% 0.947 - 2.606; P=0.073). Post-tratamiento, 15/104 (14.4%) de los
casos presentaron recurrencia: 12/15 (80%) cirugía endoscópica y 3/15 (20%) combinado (OR 4.090; IC 95% 1.202 - 18.852; P=0.612). En 16/104 (15.4%) casos
se documentó cuando menos un evento adverso. La cirugía combinada se asoció con menor tasa de eventos adversos (OR 4.534; IC 95% 1.349 - 20.78; P=0.027). Conclusión: La cirugía combinada presentó una tasa significativamente menor de recurrencia y eventos adversos en comparación para con la cirugía endoscópica.
ntroduction: There is controversy about which is the most appropriate surgical approach for inverted nasal papilloma. One reason may be the different tumor implantation sites and their extension between the studies carried out, all with small samples. To date, no similar study has been carried out in Ecuador. Objective: To analyze the advantages and disadvantages of endoscopic and combined surgeries in the treatment of inverted sinonasal papilloma according to Krause's classification. Methodology: Historical cohort carried out on patients treated at the Teodoro Maldonado Carbo Specialty Hospital (HTMC) between 2011-2020. Results: 104 cases were recovered, 56/104 (53.8%) endoscopic surgery and 48/104 (46.2%) combined, 61/104 (58.7%) were ≥60 years and 40/104 (38.5%) women. A Krouse I, II, III and IV of 24/104 (23.1%), 52/104 (50.0%), 25/104 (24%) and 3/104 (2.9%), respectively, were estimated. A location further from the nasal cavity was associated with the choice of combined approach (OR 1.552; 95% CI 0.947 - 2.606; P=0.073). Post-treatment, 15/104 (14.4%) of the cases presented recurrence: 12/15 (80%) endoscopic surgery and 3/15 (20%) combined (OR 4.090; 95% CI 1.202 - 18.852; P=0.612). In 16/104 (15.4%) cases at least one adverse event was documented. Combined surgery was associated with a lower rate of adverse events (OR 4.534; 95% CI 1.349 - 20.78; P=0.027). Conclusion: Combined surgery had a significantly lower rate of recurrence and adverse events compared to endoscopic surgery.
ntroduction: There is controversy about which is the most appropriate surgical approach for inverted nasal papilloma. One reason may be the different tumor implantation sites and their extension between the studies carried out, all with small samples. To date, no similar study has been carried out in Ecuador. Objective: To analyze the advantages and disadvantages of endoscopic and combined surgeries in the treatment of inverted sinonasal papilloma according to Krause's classification. Methodology: Historical cohort carried out on patients treated at the Teodoro Maldonado Carbo Specialty Hospital (HTMC) between 2011-2020. Results: 104 cases were recovered, 56/104 (53.8%) endoscopic surgery and 48/104 (46.2%) combined, 61/104 (58.7%) were ≥60 years and 40/104 (38.5%) women. A Krouse I, II, III and IV of 24/104 (23.1%), 52/104 (50.0%), 25/104 (24%) and 3/104 (2.9%), respectively, were estimated. A location further from the nasal cavity was associated with the choice of combined approach (OR 1.552; 95% CI 0.947 - 2.606; P=0.073). Post-treatment, 15/104 (14.4%) of the cases presented recurrence: 12/15 (80%) endoscopic surgery and 3/15 (20%) combined (OR 4.090; 95% CI 1.202 - 18.852; P=0.612). In 16/104 (15.4%) cases at least one adverse event was documented. Combined surgery was associated with a lower rate of adverse events (OR 4.534; 95% CI 1.349 - 20.78; P=0.027). Conclusion: Combined surgery had a significantly lower rate of recurrence and adverse events compared to endoscopic surgery.
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Endoscopía, Papiloma nasal, Neoplasias, Hospital de Especialidades Teodoro Maldonado Carbo, Cantón Guayaquil, Ecuador