Safety and efficacy of carbon dioxide laser therapy for vocal cord leukoplakia: A systematic review and meta-analysis.

BACKGROUND

Vocal cord leukoplakia is a precancerous lesion for which early surgical intervention following ineffective conservative treatment is the predominant approach. Carbon dioxide (CO2) laser treatment is a novel, minimally invasive therapy. However, there is insufficient evidence to suggest that CO2 laser treatment is superior to conventional surgical methods in terms of efficacy and safety. Therefore, this meta-analysis aimed to evaluate the efficacy and safety of CO2 laser treatment vs conventional surgical treatment for vocal cord leukoplakia.

METHODS

A literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across 8 databases. Studies on the use of carbon dioxide laser therapy for vocal cord leukoplakia were included in the review. Two researchers conducted a systematic search for randomized controlled trials in PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure, Wanfang, Chinese Science and Technology Periodical Database, and Chinese Biomedical Literature databases. Meta-analysis was performed using Stata 18.0, and RevMan 5.2 software.

RESULTS

The findings indicated that Compared with conventional surgery, CO2 laser surgery significantly reduced the recurrence rate of vocal cord leukoplakia (odds ratio [OR] = 0.25, 95% confidence interval, CI [0.12, 0.51]). CO2 laser surgery significantly improved the cure rate of vocal cord leukoplakia (OR = 3.07, 95% CI [1.17, 8.09]). Voice quality following CO2 laser surgery was significantly superior to that following conventional surgery, particularly in terms of fundamental frequency disturbance (standardized mean difference [SMD] = -0.8, 95% CI [-1.25, -0.34]) and amplitude disturbance (SMD = -0.52, 95% CI [-0.95, -0.09]). The CO2 laser group exhibited a lower incidence of postoperative adverse reactions (OR = 0.32, 95% CI [0.03, 3.19]); however, this difference was not statistically significant.

CONCLUSION

The results of this meta-analysis suggest that CO2 laser surgery can reduce the recurrence rate of vocal cord leukoplakia, improve the cure rate, and enhance voice quality. Therefore, CO2 laser surgery is recommended as a minimally invasive surgical approach for vocal cord leukoplakia.