Discussion
The part I of the study found that age did have a bimodal distribution
without a significant trimodal distribution. At the same time, the study
further confirmed that there are significantly different clinical
characteristics of the two types of patients with bimodal distribution,
so this study still supports the generally accepted view that RRP
patients are divided into JO-RRP or AO-RRP patients according to whether
they are over 18 years old.
The recurrence trend in the JO-RRP group was significantly earlier than
that in the AO-RRP group, and patients with JO-RRP usually had faster
disease growth, were more likely to cause airway obstruction, and
relapsed faster after treatment, which was consistent with the
characteristics of RRP disease reported in the current literature.
Bronchoscopy can directly visualize lesions of the lower respiratory
tract while specimens are collected for histopathological examination[26].For all patients with RRP in this study,
disease involves the most common site of glottis, followed by
supraglottic, consistent with previously reported results[27].
The part II of the study showed that the interval between operations was
affected by the age of onset, Derkay score, and surgical method. There
are studies found clinical features such as younger age and HPV-11
infection in patients are more dangerous[28].In
our study, or JO-RRP, the interval between operations is related to the
age of onset, Derkay score, and surgical modality, but not gender. The
interval between surgeries increases with age, and the higher the Derkay
score, the shorter the spacing between surgeries.
Microdebrider is the most commonly used surgical method, but its
surgical interval is the shortest, and the interval between CO2 laser
surgery is the longest. Microdebrider have a number of advantages that
make them suitable for JO-RRP patients. It can quickly relieve airway
obstruction, especially in patients with JO-RRP who have dyspnea due to
large lesions. Respiratory papillomatosis involving the trachea is a
challenging problem, and the selection of longer Microdebrider allows
the cutting of lesions in the trachea [29].
Unlike cold devices, CO2 lasers have a non-contact cutting function and
hemostatic effect. A German multicenter study by
Papaspyrou[15] on the status of treatment
modalities for RRP found that CO2 laser treatment was the most common
modality used alone or in combination with other treatment modalities.
On the one hand, in the KTP laser surgery protocol, patients can avoid
the risks of general anesthesia surgery, while saving a lot of time and
energy required for hospitalization, and doctors also save time for
general anesthesia waiting and preoperative preparation in local
anesthesia surgery.The process is relatively convenient, which is very
convenient for patients with repeated attacks to come to the doctor. On
the other hand, patients who choose KTP laser surgery usually have mild
disease, the lesion volume is not large and the scope is more limited,
and the voice function of postoperative patients may recover faster, and
patients experience better. For these reasons, KTP lasers are more
accessible to patients.
This study has the following limitations. First, changes in voice
function and swallowing function were not investigated pre- and
post-operatively, as retrospective studies cannot collect complete case
information, and studies in this area can be added in future prospective
studies. Secondly, we observe whether there is recurrence through
laryngoscopy, and formulate a surgical plan according to the patient’s
symptoms, but in fact, the time of the two may be somewhat different,
and each patient’s medical conditions lead to this time difference.
Third, the power of the CO2 laser or KTP laser, or cutting depth may be
one of the prognostic factors of this disease, which requires further
experimental verification.