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

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

The Laryngoscope, 2017-03, Vol.127 (3), p.550-555 [Periódico revisado por pares]

United States: Wiley Subscription Services, Inc

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  • Título:
    Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis
  • Autor: DeConde, Adam S. ; Mace, Jess C. ; Levy, Joshua M. ; Rudmik, Luke ; Alt, Jeremiah A. ; Smith, Timothy L.
  • Assuntos: Adult ; chronic disease ; Cohort Studies ; Confidence Intervals ; edema ; endoscopy ; Endoscopy - methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Nasal polyps ; 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 ; Sinusitis - epidemiology ; Sinusitis - pathology ; Sinusitis - surgery ; Treatment Outcome
  • É parte de: The Laryngoscope, 2017-03, Vol.127 (3), p.550-555
  • Notas: is a consultant for Medtronic (Jacksonville, FL), neither of which are affiliated with this investigation.
    The authors have no other funding, financial relationships, or conflicts of interest to disclose.
    is a consultant for BioInspire (Peoria, AZ).
    j.c.m.
    j.a.a.
    are supported by a grant for this investigation from the National Institute on Deafness and Other Communication Disorders, one of the National Institutes of Health, Bethesda, Maryland, U.S.A. (R01 DC005805; PI/PD: TL Smith). Public clinical trial registration
    is a consultant for Stryker Endoscopy (San Jose, CA.), and
    ,
    www.clinicaltrials.gov
    l.r.
    a.s.d.
    ID# NCT01332136. This funding organization did not contribute to the design or conduct of this study; collection, management, analysis, or interpretation of the data; preparation, review, approval or decision to submit this manuscript for publication.
    and
    t.l.s.
    are consultants for IntersectENT (Menlo Park, CA).
    ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
  • Descrição: 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
  • Editor: United States: Wiley Subscription Services, Inc
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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