Multiple surgeries for RRP – does a greater number of operations result in a worse voice outcome?
Reviewed by Chris Burgess

Recurrent respiratory papillomatosis (RRP) of the larynx remains a challenging condition to treat, with a number of affected patients requiring multiple operations to remove recurrent disease over the course of their lifetime. At the most severe end of the spectrum, operations can be required several times in the course of a single year. In this retrospective analysis of voice outcomes for 23 patients treated at a single tertiary institution in the USA, patients were divided into those that had undergone less than five procedures (Group 1, n = 11) and those who had undergone five or more procedures (Group 2, 5-50+ procedures, n = 12). Voice outcomes were assessed using blinded auditory-perceptual ratings along with cepstral and spectral acoustic measures. RRP removal was performed either in the operating room with a co2 laser or in the clinic with the KTP laser. The results of this study showed no significant differences in postoperative voice outcome measures between the two groups, both of whom showed significant improvement compared to preoperative measures. The authors conclude from this that patients requiring multiple operations do not necessarily experience a worse voice outcome, when treated using tissue-sparing surgical techniques. As an aside, it was noted that, in the 10 patients who received adjuvant cidofovir, there was no difference in the number of surgeries required, nor any difference in the meantime between surgeries. A further breakdown of the number of operations required in Group 2 and the techniques used would have been helpful given the absence of a uniform treatment approach. And the retrospective, non-randomised nature of this study means that no meaningful conclusions can be drawn regarding the potential benefits or otherwise of cidofovir. Nevertheless, it is potentially reassuring for both clinicians and patients to know that repeated laryngeal surgeries for RRP should not result in a long-term voice deficit.

Voice Outcomes Following Multiple Surgeries for Recurrent Respiratory Papillomatosis.
Parker LA, Kunduk M, Blouin D, et al.
JOURNAL OF VOICE
2020;34(5):791-8.