Recurrences of surgery for antrochoanal polyps in children: A systematic review

Objectives: The main purpose was to evaluate the recurrence rate after surgery for antrochoanal polyps (ACPs) in children; secondly, we have analyzed the rate of recurrence for different types of surgery and the risk factors involved. Methods: We performed a systematic review searching PubMed and MEDLINE databases including English language published studies from June 1989 to October 2017 regarding surgical treatment of ACPs in children. Results: We included thirteen studies, eight were retrospective and five prospective, with 285 participants, the mean rate of recurrence after ACPs surgery was 15.0% (95% CI:11.0-20.0). Functional endoscopic sinus surgery (FESS) was the main type of surgery used for primary cases (75.4%) followed by the combined approach i.e. FESS with a transcanine sinusoscopy or mini Caldwell-Luc (14%), the Caldwell-Luc (CWL) (8%) and simple polypectomy (SP) (2.8%). Our analysis has demonstrated a significant reduction of recurrences using the combined approach 0% (95% CI: 0.0-8.0) compared with FESS 17.7% (95% CI: 12.8-23.4) or SP 50% (95% CI:15.7-84.3) (p < .05) but no significant differences with CWL 9.1% (95% CI: 1.1-29.2) and others surgical approaches (p > .05). The analysis of the possible risk factors involved in recurrences are inconclusive. Conclusion: Recurrences of ACPs in children are still high. The endoscopic sinus surgery is considered the first choice for primary treatment, whilst the external approach may be a valid option in case of recurrence. It seems that the combined approach could reduce recurrence rates in selected patients that cannot be completely managed with endoscopy.