Safety of Different Surgical Modalities for Recurrent Respiratory
Papillomatosis Resection: A Systematic Review and Meta-Analysis
Abstract
Abstract 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.