Abstract Background：Recurrent respiratory papillomatosis (RRP) is recurring benign papillomatous lesions which still relies on repeated surgical treatment. However, there is no guidelines of surgical technique nowadays. Objectives: This retrospective cohort study aims to obtain a better understanding of RRP, and select the best surgical modality for RRP among microdebrider, CO2 laser and KTP laser. Study design: Retrospective cohort study. Methods: Medical records of 112 RRP patients treated at EYE&ENT Hospital of Fudan University from 2018 to 2021 were reviewed, with at least 6-month follow-up. Three treatment subgroups(microdebrider, CO2 laser and KTP laser) were analyzed within AO-RRP and JO-RRP populations respectively. Results: 112 patients (39 JO-RRP and 72 AO-RRP) and a total of 353 surgical procedures were included. Jo-RRP group had higher Derkay anatomical score(p<0.05), lower percentage of dysplasia and an earlier trend in recurrence(p<0.05) than Ao-RRP group. There were no significant differences among three surgical modalities on median treatment intervals(MTI) or survival curves(p>0.05), with the Jo-RRP MTI of the microdebrider(92.5[47.3~200]), CO2 laser(140[70~255]), KTP laser(90[62.3~221.3]), and Ao-RRP microdebrider(267.50[152.5,449.5]), CO2 laser(247.5[145.5,474.7]), KTP laser(107.5[68.3,330.5]). Conclusion and Significance: The Jo-RRP patients have more concomitant invasiveness, but less dysplasia than AO-RRP patients. Three surgical modalities appeare to be equally effective in management of Jo-RRP or AO-RRP. Key Words: Papillomatosis, surgery, treatment, recurrence, efficacy.

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.