Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis.
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Gelbard Alexander, Anderson Catherine, Berry Lynne D, Amin Milan R, Benninger Michael S, Blumin Joel H, Bock Jonathan M, Bryson Paul C, Castellanos Paul F, Chen Sheau-Chiann, Clary Matthew S, Cohen Seth M, Crawley Brianna K, Dailey Seth H, Daniero James J, de Alarcon Alessandro, Donovan Donald T, Edell Eric S, Ekbom Dale C, Fernandes-Taylor Sara, Fink Daniel S, Franco Ramon A, Garrett C Gaelyn, Guardiani Elizabeth A, Hillel Alexander T, Hoffman Henry T, Hogikyan Norman D, Howell Rebecca J, Huang Li-Ching, Hussain Lena K, Johns Michael M, Kasperbauer Jan L, Khosla Sid M, Kinnard Cheryl, Kupfer Robbi A, Langerman Alexander J, Lentz Robert J, Lorenz Robert R, Lott David G, Lowery Anne S, Makani Samir S, Maldonado Fabien, Mannion Kyle, Matrka Laura, McWhorter Andrew J, Merati Albert L, Mori Matthew C, Netterville James L, O'Dell Karla, Ongkasuwan Julina, Postma Gregory N, Reder Lindsay S, Rohde Sarah L, Richardson Brent E, Rickman Otis B, Rosen Clark A, Rutter Michael J, Sandhu Guri S, Schindler Joshua S, Schneider G Todd, Shah Rupali N, Sikora Andrew G, Sinard Robert J, Smith Marshall E, Smith Libby J, Soliman Ahmed M S, Sveinsdóttir Sigríður, Van Daele Douglas J, Veivers David, Verma Sunil P, Weinberger Paul M, Weissbrod Philip A, Wootten Christopher T, Shyr Yu, Francis David O
Аннотация
OBJECTIVE: To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease.
DESIGN, SETTING, AND PARTICIPANTS: In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook.
MAIN OUTCOMES AND MEASURES: The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications.
RESULTS: Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk.
CONCLUSIONS AND RELEVANCE: In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.