Endoscopic Sinus Surgery for Type‐2 CRS wNP: An Endotype‐Based Retrospective Study. (21st January 2019)

• Record Type: Journal Article
• Authors: Alsharif, Saeed; Jonstam, Karin; van Zele, Thibaut; Gevaert, Philippe; Holtappels, Gabriele; Bachert, Claus
• Is Part Of: Laryngoscope. Volume 129:Number 6(2019)
• Page Start: 1286
• Page End: 1292
• Publication Date: 2019-01-21
• Subjects: CRSwNP -- nasal polyps -- chronic rhinosinusitis -- endotypes -- FESS -- reboot approach; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.27815
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives: Nasal polyps are often characterized by type 2 inflammation and disease recurrence. We developed a new surgical technique, referred to as reboot approach, which aims to maximally remove all sinus mucosa and allow healthy re‐epithelialization from the preserved nasal mucosa. We here review type 2 endotype chronic rhinosinusitis with nasal polyps (CRSwNP) patients who underwent classical mucosa‐sparing endoscopic sinus surgery (ESS) or the reboot approach. Methods: Retrospective case‐control study of 50 consecutive CRSwNP patients who underwent endoscopic sinus surgery between 2015 and 2017, either as a classical non‐reboot ESS (n = 20); a partial reboot approach removing the mucosa of the ethmoidal, sphenoidal, and maxillary sinuses (n = 18); or a complete reboot approach including Draf III and removal of all frontal sinus mucosa (n = 12). Polyp recurrence over the follow‐up period of 2 years served as the primary outcome. Results: All patients demonstrated a type 2 inflammation of the mucosal tissue harvested during surgery. In the classical approach group (n = 20), nine patients relapsed within 2 years (45%); in the partial reboot group, three out of 18 patients (17%) relapsed; and in the full reboot group one out of 12 patients (8%) relapsed. The relapse rates were significantly different between the non‐reboot and the reboot groups ( P = 0.02) but also between all treatment groups ( P = 0.038). Conclusion: Complete removal of diseased mucosa from the paranasal sinuses (reboot approach) significantly reduces the recurrence of nasal polyps for 30 months postoperatively compared to the current mucosa‐sparing approach in type 2 inflammatory CRSwNP. Level of Evidence: 3b Laryngoscope, 129:1286–1292, 2019