Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis

• Authors: Adam S. DeConde, University of California San Diego; Jess C. Mace, Emory University; Joshua Michael Levy, Emory University; Luke Rudmik, University of Calgary; Jeremiah A. Alt, University of Utah; Timothy L. Smith, Emory University
• Journal Title: Laryngoscope
• Volume: Volume 127, Number 3
• Publisher: Wiley | 2017-03-01, Pages 550-555
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/lary.26391
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, Research & Experimental; Otorhinolaryngology; Research & Experimental Medicine; Nasal polyps; recurrence; sinusitis; chronic disease; endoscopy; edema; LONG-TERM OUTCOMES; QUALITY-OF-LIFE

Abstract

Objectives/Hypothesis: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a disease process that is driven, in part, by intrinsic mucosal inflammation. Surgery plus continued medical therapy is commonly elected by medically recalcitrant, symptomatic patients. The objective was to evaluate the prevalence of nasal polyp recurrence up to 18 months after endoscopic sinus surgery (ESS) with congruent continuing medical management. Study Design: Prospective, multicenter cohort of adult patients undergoing ESS for medically recalcitrant CRSwNP performed between August 2004 and February 2015. Methods: All patients received baseline nasal endoscopy quantified using Lund-Kennedy grading. All patients included for final analysis provided at least 6 months of postoperative endoscopy examinations. Multivariate analysis was used to identify risk factors for polyp recurrence. Results: Three hundred sixty-three CRSwNP patients having undergone ESS involving polypectomy were enrolled. A total of 244 (67%) participants had graded postoperative endoscopies with average of follow-up of 14.3 ± 7.0 months. Surgery plus postoperative medical management significantly improved endoscopy total scores at 6 months (P < .001). The recurrence of nasal polyposis 6 months after ESS was 35% (68/197), compared to 38% (48/125) after 12 months, and 40% (52/129) after 18 months. Multivariate analysis identified both prior ESS (odds ratio [OR]: 2.6, 95% confidence interval [CI] : 1.5-4.6; P =.001) and worse preoperative polyposis severity (OR: 1.4, 95% CI: 1.1-1.8; P =.016) as risk factors for recurrent polyposis. Conclusions: Polyp recurrence is common after ESS with control of polyps up to 18 months found in approximately 60% to 70% of patients. Investigation into both surgical and medical management strategies is warranted to improve upon the observed prevalence of recurrence. Level of Evidence: 2c. Laryngoscope, 127:550–555, 2017.