Comparing KTP and CO₂ laser excision for recurrent respiratory papillomatosis: A systematic review

Abstract

Objective The CO2 laser and 532 nm potassium titanyl phosphate (KTP) laser have been applied to treat recurrent respiratory papillomatosis (RRP). This systematic review sought to compare outcome differences between these two methods. Data Sources Embase, Web of Science, PubMed, and the Cochrane Library. Review Methods CO2 laser and KTP laser studies were obtained by keyword searches of four authoritative medical databases. Articles were screened and retained when conforming to inclusion criteria. The primary outcome was cure rate; the secondary outcomes were recurrence, death, remission, clearance, and human papillomavirus (HPV)‐detected rates, as well as laser effectiveness rates. Postoperative complications rate was the safety outcome measure. All outcomes were summarized within the CO2 and KTP groups, with results statistically compared (p < .05). Results Overall, the cure rates were 87.25% (KTP group) and 75.98% (CO2 group; p < .05). Complication rates significantly differed between the KTP (2.32%) and CO2 (17.71%) groups (p < .0001). There was a relatively higher but not significant difference in the recurrence rates between the CO2 (18.6%) and KTP (10.87%) groups (p = .1595). The CO2 group remission rate was considerably lower (38.9%) than the KTP group (88.46%, p < .0001). HPV‐detected and clearance rates were only reported for the CO2 group. The bias risks were 13.1 ± 1.45 (CO2) and 13.6 ± 1.52 (KTP) for the two groups, indicating evidence was of fair quality. Conclusion Overall, KTP laser excision showed significantly better postoperative clinical outcomes than the CO2 laser, with a lower failure rate. Available fair‐quality evidence suggests KTP laser excision might be better for treating RRP. Nevertheless, more high‐quality randomized controlled studies are needed to compare these two surgical techniques, particularly in terms of reporting functional data such as vocal outcomes.

Recurrent laryngeal papillomatosis: multimodal therapeutic strategies. Literature review and multicentre retrospective study

“…The CO 2 laser quickly gained popularity to treat RRP since the 1960s because of its fine cutting and coagulating ability, but repeated surgical sessions may result in fibrosis, scar formation, loss of the elastic properties of the mucosa of the vocal cords and voice impairment 21 .…”

“…Conversely, photoangiolytic lasers precisely target haemoglobin in highly vascularised papillomas and may have a better haemostatic effect than the CO 2 laser 19 , 21 . In particular, KTP laser wavelength is more strongly absorbed by haemoglobin, resulting in greater coagulation and less tissue damage 19 .…”

“…In particular, KTP laser wavelength is more strongly absorbed by haemoglobin, resulting in greater coagulation and less tissue damage 19 . It has been demonstrated that the application of KTP laser in laryngeal microsurgery seems to guarantee better accuracy and precision surgery, less tissue damage, shorter hospital stays and lower rate of recurrences than the CO 2 laser; nevertheless, there is still a major limitation on its widespread use because KTP laser equipment is more expensive than CO 2 lasers 21 .…”

“…In-office lasers procedures, usually performed with KTP or PDL lasers, and the newly introduced true-blue laser 2 , 20 , 22 , have offered an alternative to the traditional management under general anaesthesia. The glass fibre laser is inserted into the working channel of the video endoscope, thereby reducing costs and hospital stays, while giving the possibility to treat even small lesions that are not suitable for treatment under general anaesthesia 2 , 21 , 23 . This allows patients to maintain a better voice-related quality of life, moving the treatment goal from airway patency to a better and permanent quality of voice.…”

Microsurgery of chronic laryngeal diseases using fiber optic lasers. A review

“…Благодаря этому эпителий и собственная пластинка слизистой оболочки, покрывающие кровеносные сосуды, могут остаться неповрежденными, что способствует сохранению голосовой функции. Хорошие гемостатические способности, проникновение в ткани глубиной до 2 мм и возможность доставки данного вида излучения сквозь гибкое волокно световода обеспечивают удобство и эффективность использования при работе с сосудистыми новообразованиями [31].…”