Preventing sino-nasal polyposis recurrence after functional endoscopic sinus surgery: a multicentric study.

Area of Science:

• Otolaryngology
• Immunology
• Surgical Outcomes

Background:

• Chronic rhinosinusitis with nasal polyps (CRSwNP) often recurs post-functional endoscopic sinus surgery (FESS).
• Eosinophilic inflammation and aspirin-exacerbated respiratory disease (AERD) are key factors in CRSwNP recurrence.
• Optimizing postoperative medical regimens is crucial for managing CRSwNP recurrence.

Purpose of the Study:

• To evaluate the impact of severity-based postoperative medical regimens on CRSwNP recurrence rates after FESS.
• To determine if tailored medical strategies can reduce postoperative recurrence in CRSwNP patients.

Main Methods:

• Prospective multicentric cohort study of 144 CRSwNP patients undergoing FESS.
• Patients stratified into five groups based on eosinophilia, AERD status, and Modified Lund-Mackay (MLM)/Modified Lund-Kennedy (MLK) scores.
• Tailored postoperative medical regimens administered; two-year follow-up with MLK scoring for recurrence assessment.

Main Results:

• Overall two-year recurrence rate was 10.4%.
• Recurrence rates increased significantly with disease severity, from 0% in Group 1 to 33.3% in Group 5 (AERD).
• Blood eosinophilia and elevated IgE levels showed a strong correlation with recurrence (P < 0.001, OR = 3.15).

Conclusions:

• Tailoring postoperative medical regimens based on clinical, radiologic, and immunologic severity significantly reduces CRSwNP recurrence.
• Group-based stratification offers a feasible model for personalized CRSwNP care, particularly when biologics are unavailable.