Extent of Sinus Surgery Is Associated With Disease Control in Biologic Treated Type 2 Dominant CRS

Area of Science:

• Otolaryngology
• Immunology
• Surgical Innovation

Background:

• Biologics show increased benefit in Type 2 chronic rhinosinusitis with nasal polyps (CRSwNP) post-surgery.
• The optimal extent of sinus surgery for CRSwNP patients on biologics is not well-defined.
• This study investigates the impact of surgical extent on disease control in CRSwNP patients undergoing biologic therapy.

Purpose of the Study:

• To evaluate the influence of different surgical extents on disease control in patients with refractory Type 2 CRSwNP treated with biologics.
• To identify factors associated with successful disease control in this patient population.

Main Methods:

• Cross-sectional study of 159 CRSwNP patients treated with biologics for ≥ 6 months.
• Patients underwent sphenoethmoidectomy with extensions (Draf I-III).
• Disease control defined by SNOT-22, Lund-Mackay scores, and absence of rescue therapy; logistic regression used for analysis.

Main Results:

• 49.1% of patients achieved disease control.
• Extended surgery (Draf III/IIc) showed significantly higher disease control rates compared to less extensive procedures (Draf I/IIa).
• Biologic type did not significantly impact disease control, though class switching was noted in some patients.

Conclusions:

• Optimal disease control in CRSwNP patients on biologics is achieved through a combination of extended sinus surgery and appropriate biologic treatment.
• Extended surgical approaches, such as Draf III/IIc, are crucial for enhancing treatment outcomes in conjunction with biologics.