Surgery in Nasal Polyp Patients: Outcome After a Minimum Observation of 10 Years. Issue 4 (July 2021)

• Record Type: Journal Article
• 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
• Is Part Of: American journal of rhinology & allergy. Volume 35:Issue 4(2021)
• Page Start: 449
• Page End: 457
• Publication Date: 2021-07
• Subjects: asthma -- adult onset asthma -- chronic rhinosinusitis -- CRSwNP -- endoscopic sinus surgery -- eosinophilic-rich mucus -- follow-up -- nasal polyps -- outcome -- SNOT-22; Nose -- Periodicals; Allergy -- Periodicals; 616.21005
• DOI: 10.1177/1945892420961964
• Languages: English
• ISSNs: 1945-8924

Abstract

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.