Purpose of Review <p>The optimal management of mucosal tissues during endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) remains controversial. This systematic review and network meta-analysis aimed to compare the efficacy and safety between mucosa-preserving surgical techniques, such as functional endoscopic sinus surgery (FESS) and extended endoscopic sinus surgery (EESS), and radical mucosa-resecting endoscopic sinus surgery (RESS) for the treatment of CRSwNP.</p> Recent Findings <p>Nine studies involving 1,224 patients were included. RESS was associated with significantly lower recurrence rates compared to both FESS (relative risk [RR]: 2.37; 95% confidence interval [CI]: 1.64, 3.43) and EESS (RR: 2.22; 95% CI: 1.48, 3.36). EESS demonstrated a significantly lower revision surgery rate than FESS (RR: 2.95; 95% CI: 1.89, 4.82). Additionally, RESS showed greater improvement in overall symptom/severity visual analogue scale (VAS, 0–10&#xa0;cm) scores compared to FESS (mean difference [MD]: -2.82, 95% CI: -3.02, -2.62) and EESS (MD: -2.64, 95% CI: -4.09, -1.21). No significant differences were observed in complication rates among these surgical techniques. Besides, no statistically significant differences were found in VAS-loss of smell score, Sino Nasal Outcome Test-22 score, or Lund-Kennedy endoscopic score.</p> Summary <p>Mucosal resection during endoscopic sinus surgery is associated with reduced postoperative recurrence and improved overall symptom control in patients with CRSwNP compared to mucosal preservation techniques. The safety profiles of these surgical approaches are comparable.</p>