Surgery in Nasal Polyp Patients: Outcome After a Minimum Observation of 10 Years

• Published in: American journal of rhinology & allergy Vol. 35; no. 4; pp. 449 - 457
• Main Authors: Vlaminck, Stephan, Acke, Frederic, Prokopakis, Emmanuel, Speleman, Kato, Kawauchi, Hideyuki, van Cutsem, Jean-Christophe, Hellings, Peter W., Jorissen, Mark, Seys, Sven, Bachert, Claus, Zele, Thibaut Van, Lambrecht, Bart N., Gevaert, Philippe
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-07-2021
• Subjects: Medicin och hälsovetenskap; follow-up; SNOT-22; endoscopic sinus surgery; chronic rhinosinusitis; nasal polyps; asthma; CRSwNP; eosinophilic-rich mucus; adult onset asthma; outcome
• ISSN: 1945-8924; 1945-8932; 1945-8932
• DOI: 10.1177/1945892420961964

Background
Chronic rhinosinusitis with nasal polyps (CRSwNP) often requires surgery, but recurrence even after surgery is common. Recurrence rates largely vary in literature and asthma seems to be a comorbid factor.
Objective
In this study, we aim to estimate disease recurrence during a long-term follow-up, together with the investigation of possible predicting and/or influencing parameters.
Methods
Out of 196 patients operated for CRSwNP between 01/2000 and 01/2006, 133 patients had a follow-up of at least 10 years and could be included. The inflammatory profile at surgery was determined on nasal tissue and sinonasal secretions, and included analysis of eosinophils, eosinophilic-rich mucus (ERM) typically containing Charcot-Leyden crystals (CLC), and fungal hyphae (FH). During follow-up, recurrence, received treatments and comorbidities were collected.
Results
Out of the 133 included patients, local eosinophilia was present in 81% and ERM in 60%. Recurrence during follow-up was observed in 62%, and was associated with local eosinophilia and ERM (both p < 0.001). Asthma was present in 28% at inclusion, and 17% developed asthma after surgery during follow-up. The presence of asthma, at inclusion as well as developed during follow-up, was significantly associated with recurrence of CRSwNP (p = 0.001 for group comparison).
Conclusion
Recurrence after CRSwNP surgery is common when a long-term follow-up is taken into account. ERM detected in sinonasal secretions at surgery seems to be a predictive factor for recurrence and need for revision surgery. Asthma is a frequently found comorbid factor in CRSwNP, develops even at higher age despite surgical treatment for CRSwNP, and is also associated with a higher recurrence rate. Sustained medical care after surgery is mandatory.