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Published on: January 20, 2010
Topical mitomycin application after laryngotracheal reconstruction: a randomized, double-blind, placebo-controlled
C J Hartnick1, B E Hartley, P D Lacy
1Department of Pediatric Otolaryngology, Children's Hospital Medical Center, Cincinnati, Ohio, USA. christopher_hartnick@meei.harvard.edu
Insights
Topical mitomycin did not show a significant benefit over saline for pediatric airway stenosis after laryngotracheal reconstruction. Further research is needed to confirm these findings in pediatric airway surgery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Pharmacology
Background:
- Subglottic stenosis is a common complication after laryngotracheal reconstruction in children.
- Mitomycin C is an antifibrotic agent that has been used to prevent airway stenosis.
- The efficacy of topical mitomycin in pediatric airway reconstruction remains unclear.
Purpose of the Study:
- To evaluate the effectiveness of a single topical dose of mitomycin compared to isotonic sodium chloride in preventing granulation tissue formation after pediatric laryngotracheal reconstruction.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted.
- Children aged 2-17 years with subglottic or upper tracheal stenosis received either mitomycin or saline applied topically to the subglottic region postoperatively.
- Airway assessment via endoscopy was performed at 2 weeks, 6 weeks, and 3 months.
Main Results:
- Interim analysis at 1 year showed no significant difference in outcomes between the mitomycin and placebo groups.
- The Data Monitoring and Safety Committee recommended stopping the trial due to similar distributions between treatment arms.
- Granulation tissue formation and need for further surgical intervention were comparable in both groups.
Conclusions:
- A single topical dose of mitomycin does not appear to offer additional benefit over isotonic sodium chloride for pediatric airway reconstruction.
- The null hypothesis, stating equal benefit between mitomycin and saline, could not be rejected.
Objective:
To explore the effect of mitomycin treatment on the pediatric airway following laryngotracheal reconstruction.
Design:
Randomized, double-blind, placebo-controlled trial.
Patients:
Children aged 2 to 17 years with subglottic or upper tracheal stenosis undergoing laryngotracheal reconstruction at a single, tertiary care, children's hospital.
Intervention:
At the time of extubation or stent removal, the children underwent bronchoscopy and 0.4 mg/mL (2 mL of a 0.2-mg/mL solution of either mitomycin or an equal volume of isotonic sodium chloride was directly applied to the subglottic region for a single application of 2 minutes. These children then underwent interval endoscopy at 2 weeks, 6 weeks, and 3 months postoperatively for assessment of their airways.
Results:
Granulation tissue was graded on a scale of 0 (none) to 4 (near-total or total occlusion). Videotapes of endoscopies were independently observed and graded by 3 pediatric otolaryngology fellows with a subsequent interobserver agreement of 91.6%. The results were then dichotomized to represent a single cohort in which further surgical intervention would be required and another separate cohort in which further surgery would not be required. At the 1-year mark, interim analysis was performed by a Data Safety and Monitoring Committee. At this time, 13 children had been randomized to the mitomycin-treated arm of the study and 11 children to the placebo-treated arm. A 2-tailed Fisher exact test revealed a value of 1.00. The Data Monitoring and Safety Committee advised that the trial should be stopped because the distributions between the 2 populations were almost identical.
Conclusion:
We cannot reject the null hypothesis that a single topical dose of mitomycin exerts an equal benefit as does isotonic sodium chloride when applied to the pediatric airway after laryngotracheal reconstruction.
