Symptom-Free Intervals Following Laser Wedge Excision for Recurrent Idiopathic Subglottic Stenosis

Area of Science:

• Otolaryngology
• Airway Surgery
• Pediatric Surgery

Background:

• Recurrent idiopathic subglottic stenosis (iSGS) poses a significant management challenge.
• Laser wedge excision (LWE) is a treatment option for iSGS.
• Understanding symptom-free intervals is crucial for managing iSGS.

Purpose of the Study:

• To analyze the duration of symptom-free intervals following LWE for iSGS.
• To evaluate factors influencing these intervals, including patient history and disease characteristics.

Main Methods:

• Retrospective review of 210 iSGS patients undergoing LWE (2002-2021) at a tertiary center.
• Patients categorized as LWE primary (LWEP) or LWE secondary (LWES) based on prior airway surgery.
• Conditional frailty repeated events model used to analyze median time to recurrence (MTR).

Main Results:

• Symptom-free intervals significantly shortened with each subsequent recurrence.
• Median time to recurrence (MTR) decreased exponentially from 4.1 years after the first LWE to 0.7 years by the 12th recurrence.
• LWEP patients had longer MTR than LWES patients within the first 6 recurrences.

Conclusions:

• Symptom-free intervals following LWE for iSGS diminish with increasing recurrences.
• Initial surgical history (LWEP vs. LWES) impacts the duration of symptom-free intervals, particularly early on.
• Disease and patient factors did not significantly correlate with intersurgical intervals beyond the first recurrence.