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 larynx,and 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.