Surgical and Voice Outcomes of Office-Based Recurrent Respiratory Papillomatosis Surgery: A Systematic Review.

OBJECTIVE

To investigate the surgical and voice outcomes associated with office-based laryngeal surgery for the treatment of recurrent respiratory papillomatosis (RRP).

DATA SOURCES: PubMed, Google Scholar, and Cochrane databases.

REVIEW

METHODS

Two independent investigators search databases for studies reporting surgical or voice quality outcomes of patients treated with office-based surgery for RRP according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Primary outcomes consisted of surgical (safety, patient tolerance, recurrence, complications, number of interventions) and voice quality (subjective, aerodynamic, and acoustic measurements) outcomes. The bias analysis was conducted through the Methodological Index for Non-Randomized Studies (MINORS).

RESULTS

Fifteen studies (13 retrospective, 2 prospective) met inclusion criteria, accounting for 357 patients with RRP mainly treated with PDL, KTP, and Blue Laser office-based surgery. Surgical outcomes reported 50% to 95.8% lesion regression rates. The patient tolerance was good, with smokers reporting the low level of tolerance. The cumulative complication rate was low (1.62%). Voice quality assessments demonstrated significant improvements in subjective measures (VHI-10, GRBAS), while there was no study reporting multidimensional voice quality assessments including subjective, perceptual, aerodynamic, and acoustics measurements. Methodological quality of included studies was low-to-moderate (MINORS scores: 5-9), with inconsistent reporting of confounding factors.

CONCLUSION

Office-based laser surgery is a safe and effective treatment for vocal fold RRP, with an effective reduction of disease burden, satisfactory regression, and a moderate rate of subsequent need for OR management. Future studies are needed to investigate the long-term multidimensional voice quality outcomes related to office-based procedures and to compare them with operating room procedures.