Evaluation of prognostic factors associated with antrochoanal polyp recurrence: Case series and literature review.

INTRODUCTION AND IMPORTANCE

Despite being non-neoplastic and usually unilateral, antro-choanal polyps have a notable tendency to recur following surgical treatment, particularly when incomplete removal of the polyp's antral portion occurs. Understanding the mechanisms and risk factors associated with ACP recurrence is crucial for optimizing treatment strategies and minimizing the likelihood of relapse. The main objective of this study was to identify and analyze the prognostic factors associated with recurrence of this benign but potentially recurrent pathology.

METHODS

This is a retrospective study of a series of 27 patients operated for an antrochoanal polyp (ACP). The study was carried out over a five-year period, from January 2, 2017 to July 5, 2024. All patients, regardless of age or sex, who underwent surgery for an antrochoanal polyp during this period were included in the study.

RESULTS

A total of 21 patients had no recurrence during follow-up. Of these, 14 patients (67 %) underwent endoscopic nasal endoscopy with meatotomy. However, 7 patients (33 %) underwent Caldwell-Luc (CWL) approach associated with endoscopic surgery. Recurrence was noted in 6 patients (22.22 %). The mean time to recurrence was 22 months, of which 4 (66 %) recurred before 16 months. We found that 50 % of patients who recurred (3 cases) were aged between 13 and 36, 17 % were under 13 (1 case) and 33 % were over 36 (2 cases). Recurrences were equally distributed between the genders, with a sex ratio of 1. All patients who had recurrence were of urban origin. Three patients, i.e., 50 % of those who recurred, had a rhino-sinus history. All patients who had relapsed underwent exclusive endonasal endoscopy with middle meatotomy for removal of the sinus component of ACP. Also, all patients had a tumor size greater than 5 cm. Following the results of our analytical study between the relapsed group (6patients) and the non-relapsed group (21patients), there were three prognostic factors found to be significantly associated with relapse with a p value <0.05. Associated endonasal pathology (p = 0.040) increases risk of recurrence. Tumor size ≥5 cm (p = 0.005). Incomplete surgical excision (p = 0.020).

CONCLUSION

Relapse of antrochoanal polyps is often due to incomplete surgical removal and persistent inflammation. Proper identification of recurrence risk factors and the use of complete endoscopic excision with wide maxillary antrostomy are essential to reduce recurrence. Long-term follow-up is crucial for early detection and effective management.