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

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.

Embase, Web of Science, PubMed, and the Cochrane Library.

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).

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.

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.