Background: Currently, the most common surgical modalities used for recurrent respiratory papillomatosis (RRP) resection are microdebrider, carbon dioxide (CO 2 ) laser and potassium-titanyl-phosphate (KTP) laser. However, complication rates vary among different surgical modalities and have been controversial in different studies.Objective of Review: This study systematically reviews the available studies which reported intra-operative and post-operative complications, aiming to compare the safety of microdebrider, CO 2 laser and KTP laser.
Background: Currently, the most common surgical modalities used
for recurrent respiratory papillomatosis resection are microdebrider,
CO2 laser, and KTP laser. However, complication rates vary among
different surgical modalities and have been controversial in different
studies. Objective of review: This study systematically reviews the
available studies which reported intraoperative and postoperative
complications, aiming to compare the safety of microdebrider, CO2 laser,
and KTP laser. Type of review: Meta-analysis. Search strategy: Seven
electronic databases (PubMed/MEDLINE, EMBASE[Ovid], Scopus, Cochrane
Library, and Web of Science) were searched from inception through April
28th,2022. Randomized controlled, prospective or retrospective
observational studies that recorded the complications of three different
surgical modalities for recurrent respiratory papillomatosis resection
were included in the meta-analysis. Evaluation method: Outcomes of
interest were intraoperative and postoperative complications, and
complication rate was calculated to evaluate the safety of surgical
methods. Results: Twenty different studies was included in quantitative
synthesis. Only one study compared outcomes of those three kinds of
treatment modalities simultaneously, two studies compared microdebrider
and CO2 laser, and the remaining studies focused on only one of three
treatments. The weighted average complication rate for microdebrider was
0.03(95% confidence interval [CI] 0.00-0.21), n = 6, for CO2 laser
treatment was 0.16 (95% confidence interval [CI] 0.09-0.25), n =
14,and for KTP laser treatment was 0.04 (95% CI 0.00-0.14), n =4.
Conclusion:The limited evidence demonstrated that CO2 lasers in the
surgical treatment of RRP may lead to more surgical complications, and
microdebrider and KTP lasers may be safer. However, the heterogeneous
data limits any strong comparison of outcomes of different treatment of
laryngeal papillomas. Future randomised controlled trials that directly
compare the safety of different surgical modalities are needed.
Background:Recurrent respiratory papillomatosis (RRP) is
recurring benign papillomatous lesions which still relies on repeated
surgical treatment. However, there is no guidelines of surgical
technique nowadays. Objectives: This retrospective cohort study aims to
obtain a better understanding of RRP, and select the best surgical
modality for RRP among microdebrider, CO2 laser and KTP laser. Study
design: Retrospective cohort study. Methods: Medical records of 112 RRP
patients treated at EYE&ENT Hospital of Fudan University from 2018 to
2021 were reviewed, with at least 6-month follow-up. Three treatment
subgroups(microdebrider, CO2 laser and KTP laser) were analyzed within
AO-RRP and JO-RRP populations respectively. Results: 112 patients (39
JO-RRP and 72 AO-RRP) and a total of 353 surgical procedures were
included. Jo-RRP group had higher Derkay anatomical
score(p<0.05), lower percentage of dysplasia and an earlier
trend in recurrence(p<0.05) than Ao-RRP group. There were no
significant differences among three surgical modalities on median
treatment intervals(MTI) or survival curves(p>0.05), with
the Jo-RRP MTI of the microdebrider(92.5[47.3~200]),
CO2 laser(140[70~255]), KTP
laser(90[62.3~221.3]), and Ao-RRP
microdebrider(267.50[152.5,449.5]), CO2
laser(247.5[145.5,474.7]), KTP laser(107.5[68.3,330.5]).
Conclusion and Significance: The Jo-RRP patients have more concomitant
invasiveness, but less dysplasia than AO-RRP patients. Three surgical
modalities appeare to be equally effective in management of Jo-RRP or
AO-RRP. Key Words: Papillomatosis, surgery, treatment, recurrence,
efficacy.
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