FLEX October 2023

15314995, 2023, 8, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/lary.30547 by Wake Forest Univesity, Wiley Online Library on [18/08/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

Fig. 3. Forest plots of the pooled analysis for (A) GRBAS after one-year follow-up; (B) VHI within 6 months; (C) VHI after one-year follow-up. [Color fi gure can be viewed in the online issue, which is available at www.laryngoscope.com.]

signi fi cant increase in recurrence risk in either group with anterior commissure involvement. 33 In the study by Strieth and colleagues, the recurrence rate in KTP compared to CO 2 was 0% versus 27%, respectively. 32 Similarly, Parker et al. reported a very low recurrence rate of 2% following KTP. 28 These fi ndings indicate that KTP is associated with a similar recurrence rate to radiotherapy and CO 2 . Because the KTP laser is easily used in the of fi ce, surgeons will proactively ablate small laryngeal lesions as a prophylactic measure to prevent any potential neo plastic process from maturing. Additionally, of fi ce man agement may obviate the need for a return trip to the operating room. This widely utilized approach might result in over-estimating the need for retreatment for oncologic reasons in the present meta-analysis. Parker et al. suggested that proactive retreatment with KTP for any lesion should be considered as a part of management algorithm. Hence, the retreatment rate with KTP should

not be considered as a response to an oncologic recur rence. Nonetheless, strict postoperative patient follow-up should be implement and, hence, KTP may not be suit able for patients who would not be able to attend frequent follow-up visits. 28 The overall VHI estimate attributed to KTP in the single-arm meta-analysis was 6.15 and 2.25 within 6 months and after a one-year follow-up, respectively. One-year GRBAS single-arm meta-analyses of KTP reported a pooled estimate of 3.51. According to Lahav et al., KTP improved both GRBAS and VHI scores similar to CO 2 laser. There was greater preservation of vocal fold vibration and mucosal wave propagation in the KTP group. 30 This fi nding suggests that the KTP laser ablative technique may better preserve vocal fold architecture and result in better function. Similarly, Strieth et al. reported that KTP laser resulted in superior functional voice out comes, assessed by 6-month VHI, in early-stage laryngeal cancer compared to CO 2 laser. 32 On the other hand, a

Laryngoscope 133: August 2023

Suppah et al.: KTP in Glottic Neoplasms

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