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

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.