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

Chronic rhinosinusitis with nasal polyps (CRSwNP) frequently recurs after functional endoscopic sinus surgery (FESS), particularly in patients with eosinophilic inflammation or aspirin-exacerbated respiratory disease (AERD). Optimizing postoperative medical regimens based on disease severity may reduce recurrence rates. The aim of this study was to evaluate the impact of severity-based postoperative medical regimens on recurrence rates following FESS in patients with CRSwNP.

This prospective multicentric cohort study included 144 patients with CRSwNP who underwent FESS between 2021 and 2023. Patients were stratified into five groups based on eosinophilia, AERD status, and radiologic/endoscopic severity using the Modified Lund-Mackay (MLM) and Modified Lund-Kennedy (MLK) scores. Each group received a tailored postoperative medical regimen. Patients were followed for two years, with recurrence assessed via nasal endoscopy and scored using MLK.

The overall recurrence rate at two years was 10.4%. Recurrence rates increased progressively from 0% in Group 1 (non-eosinophilic) to 33.3% in Group 5 (AERD). The trend was statistically significant (Cochran-Armitage test, Z = 3.48, P < 0.001). A significant association between follow-up group and recurrence was found (Chi-square, P = 0.006, Cramér's V = 0.316). Blood eosinophilia and elevated IgE levels were strongly correlated (P < 0.001, OR = 3.15).

Postoperative recurrence in CRSwNP can be significantly reduced by tailoring medical regimens based on clinical, radiologic, and immunologic severity. Group-based stratification provides a feasible model for personalizing care, especially in settings where biologics are unavailable.