Edi Handoko, Rizki Ekaputra Handoko, Ahmad Dian Wahyudiono
Objective: To synthesize existing systematic reviews to determine the true long-term recurrence rate of cholesteatoma following primary surgery, and to evaluate the comparative effectiveness of surgical approaches (CWU vs CWD) and adjunctive procedures on disease recidivism. Methods: A systematic search of PubMed, Scopus, and OpenAlex identified 23 studies (predominantly systematic reviews and meta-analyses) encompassing 12,819 patients with ≥ 12 months' follow-up and clearly defined recurrence, evaluating canal wall up (CWU), canal wall down (CWD), mastoid obliteration, and endoscopic assistance. Results: Recurrence increased from 7% at 12 months to 39% at 15 years. CWD showed lower recurrence than CWU. Mastoid obliteration (odds ratio 0.33.0.45) and endoscopic techniques (risk ratio 0.48-0.68) reduced recidivism and residual disease. Age and staged surgery increased risk, whereas planned second-look surgery was protective. Conclusion: Cholesteatoma recurrence is strongly time-dependent. Combining appropriate surgical techniques with mastoid obliteration, endoscopic assistance, and long-term surveillance improves long-term disease control. © The Author(s), 2026. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.
Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Brawijaya, Dr. Saiful Anwar general Hospital, East Java, Indonesia
