Introduction
Recurrent respiratory papillomatosis(RRP) and its potential malignant
degeneration have a clinical history of about 100 years, and we have
gradually recognized that the etiology of RRP is related to HPV virus
infection[1]. Epidemiological investigations have
found three peaks in the age distribution of onset: 7, 35, and 64
years[2]. However, RRP has usually been subdivided
into juvenile-onset RRP and adult-onset RRP, with the variable age of
demarcation used in different studies[3-6]. The
juvenile-onset RRP is generally more aggressive than the adult-onset
RRP, with a high recurrence rate and a stronger propensity to
spread[7]. RRP is characterized by recurrent
papillomatous lesions that occur primarily in the larynx but
occasionally involve other parts of the aerodigestive
tract[8].
At present, there is still no cure for RRP[9]. The
main treatment for Recurrent respiratory papillomatosis is still
repetitive surgery, which aims to maintain airway patency without
effectively preventing recurrence[10][11]. Surgical treatment with traditional cold
instruments, microdebriders, 10,600nm
carbon dioxide(CO2) laser, 532-nm
pulsed potassium-titanyl-phosphate(KTP) laser is usually
preferred[12]. But there is no standard guidelines
for the choice of surgical technique. Factors that can influence
decision-making are the effectiveness and safety of surgical techniques,
patient factors, and surgeon preferences[13].
As for the efficacy, according to the outcomes of studies, different
surgeries appear to be comparable in removing lesions and preventing
recurrence. Papaioannou[14] reported that
conventional cold instrument and laser surgery both had no effect on
postoperative recurrence time or the number of surgeries per year,
regardless of whether the JORRP and AORRP populations were analyzed
separately. Hock[15] analyzed
the efficacy of RRP treated with
three surgical modalities(KTP, CO2, and microdebrider) in a large
retrospective study, and found no significant difference in mean
intervals among the three treatment groups when analyzing people with
AO-RRP. Preuss[16] also suggests that there is no
correlation between different surgical modalities and the recurrence
rate of RRP. In other words, these commonly used surgical
modalities seem to have the equally
effective on RRP.
Therefore, safety should be taken into account before making a decision
on the choice of surgical method. The common complications of surgery
were scar tissue and web formation in the anterior commissure of the
larynxļ¼and Laryngeal stenosis et al. Due to the high recurrence rate of
RRP, repeated surgery is required to reduce tumors, and delayed
complications during or after surgery will affect the quality of
breathing and voice, which in turn will affect the quality of
life[17].
However, complication rates vary among different surgical modalities and
have been controversial in different studies.
Preuss[18] reported the overall incidence of soft
tissue complications after CO2 laser surgery is significantly lower and
the rate of tracheostomy is lower compared to laryngeal microsurgery
with cold instruments. On the contrary,
Hermann[19] found a statistical trend towards an
association between the use of laser and the presence of sequelae
lesions. Similarly, Rasmussende[20] argue that
lasers are not optimal choice, in contrast to microdebriders that are
simple to operate and result in less scar
tissue.
Scatolini[21] reported that a higher rate of
sequelae was found in patients in whom laser was used together with
microlaryngeal instruments. However, unlike the results of the studies
mentioned above, Papaioannou supports the view that there is no
significant difference in complications after conventional cold surgery
and laser surgery[3].
As can be seen from the data on the
available instruments above, the rate of complications reported for each
is variable. On the one hand, cold steel instruments (like
microdebrider) avoid heat transfer to the surrounding tissue and thereby
the possibility of scar retraction. On the other hand, hot methods
(laser) allow for better hemostasis and vaporization of the flat
superficial lesions while preserving normal tissue. Therefore, this
study will conduct a literature review to compare the types and
incidence of surgical complications between different surgical
modalities, and provide evidence for making decisions on surgical
modality.