Endoscopic treatment of laryngeal and tracheal stenosis—has mitomycin C improved the outcome?

Abstract

OBJECTIVE: The management of laryngeal and tracheal stenosis remains a challenging problem despite advances in endoscopic surgical techniques. Scar formation and restenosis is the main cause of failure, and this study assesses the efficacy of two adjuvant treatments: endoscopic steroid injection and topical mitomycin C application. STUDY DESIGN AND SETTING: This is a retrospective cohort study comparing the efficacy of 3 endoscopic techniques: (1) carbon dioxide (CO2) laser incisions with bronchoscopic dilatation, (2) CO2 laser with dilatation followed by steroid injection into the stenotic area, and (3) CO2 laser with dilatation followed by topical application of mitomycin C. Included in the statistical analysis were 47 procedures performed by the senior investigator in a tertiary medical center between 1994 and 2001 based on their success or failure. RESULTS: The percentages of successful outcomes in the study groups were 15%, 18.2%, and 75% with the CO2 laser, CO2 laser with steroid injection, and CO2 laser with mitomycin C, respectively. Statistical comparisons reveal that the differences in outcomes were statistically significant ( P < 0.05) between the mitomycin group and each of the other two treatment groups, whereas there was no statistically significant difference between the laser only and laser with steroid groups. There were no complications noted with the use of adjuvant medications. CONCLUSION: These patient group results indicate a statistically significant increase, from <20% to 75%, in the success rate of endoscopic treatment of acquired upper airway stenosis when topical mitomycin C is added to the treatment regimen. No benefit has been demonstrated for using intraoperative local steroid injections as an adjunct to laser treatment. CLINICAL SIGNIFICANCE: Mitomycin C appears to be an effective and safe adjuvant treatment in the endoscopic management of laryngeal and tracheal stenosis.