Results
There were 112 patients (39 JO-RRP patients and 72 AO-RRP patients) met inclusion criteria, and a total of 353 surgical procedures were included. The average age was 7.4(JO-RRP patients) and 46(Ao-RRP patients), respectively. The female–male ratio is 16:23 in Jo-RRP patients, and 19:54 in Ao-RRP patients. There were 181 procedures performed in Jo-RRP group, with either the microdebrider(n=152), CO2 laser(n=18), or KTP laser(n=11), and 172 procedures were performed in Ao-RRP, with either the microdebrider (n=46), CO2 laser(n=102), or KTP laser(n=24). It can be seen that surgeons prefer to use microdebrider in Jo-RRP treatment and CO2 laser in adult patients.
The treatment intervals(days) in the JO-RRP population(median[P25-P75], 99[50,205]) was shorter compared to AO-RRP population(median[P25-P75], 230.0[132.0,455.0])(p<0.05)(Fig.1A). Besides, the JO-RRP patients had higher Derkay anatomical score(mean [SD], 13.0[6.2]) than AO-RRP patients(mean [SD], 6.95[4.90]) (p<0.05)(Fig.1B), and it is conceivable that there were more Jo-RRP patients with dyspnea symptom at the first visit(17/39, 43.6%) compared to AO-RRP patients(8/72, 11.1%). JO-RRP patients had significantly worse disease burden at initial procedure compared to AO-RRP patients. These findings corroborate previous studies suggesting a more aggressive disease course in children, which necessitates more regimented intervals until the child’s airway has grown. The most susceptible anatomical site of lesions is the glottis in both of these two groups, followed by the supraglottic and subglottic. However, postoperative pathological result of each procedure showed that the proportion of histopathology containing dysplasia in JO-RRP group(7/181, 3.9%) was smaller than that in AO-RRP group(105/172, 61.0%) (Table I.).
We also performed subgroup analyses according to the surgical modalities(Table II). In addition to age of onset, disease regression measured by the Derkay scoring system was comparable among the treatment groups. For the pediatric patients, the treatment intervals(Days) in the microdebrider group (median[P25-P75], 92.5[47.3~200]), CO2 group (median[P25-P75], 140[70~255]), KTP group (median[P25-P75], 90[62.3~221.3]). For the adult patients, the treatment intervals(Days) in the microdebrider group (median[P25-P75], 267.50[152.5,449.5]), CO2 group (median[P25-P75], 247.5[145.5,474.7]), KTP group (median[P25-P75], 107.5[68.3,330.5]). CO2 laser surgery represented the longest treatment interval both in Jo-RRP and Ao-RRP patients, but no significant differences were found among three subgroups(p>0.05)(Fig.2).
The recurrence trends of patients used three different surgical modalities were no significant difference(p>0.05), but Jo-RRP group has a clearly earlier trend in recurrence than Ao-RRP group(p<0.05)(Fig.3). That is to say, three surgical modalities appeare to be equally effective in management of Jo-RRP or AO-RRP, which is encouraging for institutions that do not have laser modalities readily available. Other factors of decision-making on surgical modalities need to be focused in future studies.