Key points:
- CO2 and KTP laser were developed to treat LP, but the
differences in their outcomes have not been systematically summarized.
- This review was conducted through three databases involving 283
related studies, and 15 of them met the inclusion criteria.
- KTP laser might result in a superior outcome and lower postoperative
complication rate than CO2 laser for LP.
- HPV positive rate, remission rate, and clearance rate for LP are
suggested to be reported in future studies.
- High-quality randomized controlled studies are needed to further
evaluate the benefits of the two surgical techniques.
Introduction
Laryngeal papillomatosis (LP) is a benign tumor that can involve the
whole respiratory tract and upper digestive tract1. It
is also termed as recurrent respiratory papillomatosis(RRP) due to its
high recurrence rate postoperatively and multiple surgeries are
frequently required2. In general, LP can be divided
into juvenile-onset and adult-onset LP3. The reported
incidence rate is 0.17 and 0.54 per 100 000 people for juvenile-onset
and adult-onset LP, respectively4. Its morphological
characteristics appeared with many abnormal exophytic projections, one
of which is composed of a center of connective tissue covered with
squamous epithelium5,6. Although benign, LP is chronic
and can significantly influence on life style due to requiring multiple
operations and significant financial impact, scarring, airway
obstruction, hoarseness, and rare but the potential for malignant
transformation4,7,8.
Currently, no definite treatment modality for LP is yet available,
clinical management of LP is mainly rely on repeated careful surgical
resections with preservation of non-infected
tissue9,10. Besides, the treatment for LP in clinical
is still frustrating on account of unpredictable outcomes, the tendency
for recurrence, and intractable complicates11,12.
Effective prevention of complicates is one of the main targets for
treatments, which could be the important criteria for evaluating
treatment methods2,3,13. Surgical excision in the
operating room under general anesthesia is the traditional management
method1,14,15. Powered by advanced technology, a
direct laryngoscopic approach started in the 20thcentury16,17. Afterwards, with the development of the
carbon dioxide (CO2) laser in the 1960s, it quickly
became popular in laryngology but multiple complications, such as
thermal injury, significantly limited its
applications1,18,19. Subsequently, the 585-nm pulsed
dye laser (PDL) was first introduced in 2001 to manage PL with a fiber
delivery system of absorbable
energy20,21. However, bleeding caused by PDL and its
extremely short pulse width blocked the further application of this
technology2,22,23. Furthermore, adjuvant antiviral
drugs have been administrated and studied for increasing therapeutic
effects in recent years, but their therapeutic effects have not been
confirmed24–26.
In the past thirty years, photoangiolytic laser-the 532-nm potassium
titanyl phosphate laser (KTP), has been widely applied in office-based
laryngeal surgical procedures27–29. Many studies have
been reported successful treatment of multiple vocal diseases, such as
papilloma, varix, polyp, Reinke edema, vocal process granuloma, ectasia,
and glottal dysplasia29. The angiolytic properties of
KTP shrink lesions through photothermolysis and the laser energy can be
absorbed by hemoglobin10,30,31. With those advantages,
KTP laser seems to be the promising modality of LP treatment. However,
in China(and neighboring countries), the CO2 laser is
being used as the first-choice modality for LP applied by most
hospitals. To date, there was no consensus or comparison study on which
laser is better for LP therapy.
This review aims to evaluate and compare the cure, complications, and
recurrence rates of CO2 and KTP lasers for LP. We
hypothesized that KTP laser could yield comparatively better outcomes
than CO2 laser for LP.
Method
The study was performed according to PRISMA32 and the
check list was presented in Appendix S1.