Comparing suspension laryngoscopic mucosal dissection and plasma resection for laryngeal leukoplakia: prognostic outcomes.

OBJECTIVE

The current research was designed to compare the clinical efficacy of suspension laryngoscopic mucosal dissection and plasma resection in the management of laryngeal leukoplakia and their effects on patient prognosis.

METHODS

Retrospective analysis was conducted on 184 laryngeal leukoplakia patients treated in Ningbo Beilun People's Hospital from January 2018 to October 2021. Based on the inclusion and exclusion criteria, 128 eligible patients were included, including 64 patients who underwent suspension laryngoscopic mucosal dissection (control group) and 64 patients who underwent cryolyrectomy (study group). The operative time, intraoperative bleeding volume, and time of pseudomembrane detachment in the two groups were recorded. Enzyme-linked immunosorbent assay (ELISA) was used to determine the serum concentrations of interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α, interferon-γ (IFN-γ), and IL-17A at 24 hours after surgery. Postoperative follow-up was conducted for one year. Results of the noise acoustic testing and stroboscopic laryngoscopy, including noise/harmonic ratio, amplitude perturbation, fundamental frequency perturbation, vocal fold vibration symmetry, and vocal fold mucosal wave, were documented before treatment and three months after treatment. The cumulative recurrence rate of patients within one year after surgery was recorded, and the cumulative recurrence rate of patients within 1 year after surgery was compared between the two groups.

RESULTS

Cryo-plasma resection significantly contributed to shorter operative time and less intraoperative bleeding volume as compared with suspension laryngoscopic mucosal dissection (both P<0.05), while time-lapse before postoperative pseudomembrane detachment was similar between the two groups (P>0.05). Patients with cryo-plasma resection exhibited significantly milder postoperative inflammatory response than those with suspension laryngoscopic mucosal dissection, as evinced by the lower serum concentrations of IL-2, IL-6, TNF-α, IFN-γ and IL-17A at 24-h in patients with cryo-plasma resection after operation (P<0.05), while the levels of IL-4 and IL-10 were similar between the two groups (P>0.05). At 3 months after operation, cryo-plasma resection contributed to more significant reductions of noise/harmonic ratio, amplitude perturbation, fundamental frequency perturbation, vocal fold vibration symmetry, and vocal fold mucosal as compared with suspension laryngoscopic mucosal dissection (P<0.05). Cryo-plasma resection contributed to a significantly lower incidence of cumulative recurrence than suspension laryngoscopic mucosal dissection (P<0.05). Multivariate analysis revealed no statistical difference in the impact of gender, age, smoking, and alcohol consumption on the recurrence and malignant transformation of laryngeal leukoplakia (P>0.05).

CONCLUSION

Both suspension laryngoscopic mucosal dissection and plasma resection can provide significant efficacy in the treatment of laryngeal leukoplakia, and cryo-plasma resection can contribute to a lower incidence of relapse, enhanced postoperative recovery, and superior short- and long-term outcomes than plasma resection.