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

Adam S DeConde; Jess C Mace; Joshua M Levy; Luke Rudmik; Jeremiah A Alt; Timothy L Smith

doi:10.1002/lary.26391

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

Laryngoscope. 2017 Mar;127(3):550-555. doi: 10.1002/lary.26391. Epub 2016 Nov 12.

Authors

Adam S DeConde¹, Jess C Mace², Joshua M Levy³, Luke Rudmik⁴, Jeremiah A Alt⁵, Timothy L Smith²

Affiliations

¹ Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, U.S.A.
² Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
³ Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology and Anterior Skull Base, Emory University Hospital, Atlanta, Georgia, U.S.A.
⁴ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
⁵ Division of Otolaryngology-Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah, Salt Lake City, Utah, U.S.A.

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.

Trial registration: ClinicalTrials.gov NCT01332136.

Keywords: Nasal polyps; chronic disease; edema; endoscopy; recurrence; sinusitis.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural

MeSH terms

Adult
Cohort Studies
Confidence Intervals
Endoscopy / methods*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Multivariate Analysis
Nasal Polyps / epidemiology*
Nasal Polyps / pathology
Nasal Polyps / surgery
Nasal Surgical Procedures / methods
Odds Ratio
Prevalence
Prospective Studies
Recurrence
Rhinitis / epidemiology
Rhinitis / pathology
Rhinitis / surgery*
Risk Assessment
Sinusitis / epidemiology
Sinusitis / pathology
Sinusitis / surgery*
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01332136

Grants and funding

R01 DC005805/DC/NIDCD NIH HHS/United States