Comparative Treatment Outcomes for Patients With Idiopathic Subglottic Stenosis

被引:116
|
作者
Gelbard, Alexander [1 ]
Anderson, Catherine [1 ]
Berry, Lynne D. [2 ]
Amin, Milan R. [3 ]
Benninger, Michael S. [4 ]
Blumin, Joel H. [5 ]
Bock, Jonathan M. [5 ]
Bryson, Paul C. [4 ]
Castellanos, Paul F. [6 ]
Chen, Sheau-Chiann [2 ]
Clary, Matthew S. [7 ]
Cohen, Seth M. [8 ]
Crawley, Brianna K. [9 ]
Dailey, Seth H. [10 ]
Daniero, James J. [11 ]
de Alarcon, Alessandro [12 ]
Donovan, Donald T. [13 ]
Edell, Eric S. [14 ]
Ekbom, Dale C. [15 ]
Fernandes-Taylor, Sara [10 ]
Fink, Daniel S. [7 ]
Franco, Ramon A. [16 ]
Garrett, C. Gaelyn [1 ]
Guardiani, Elizabeth A. [17 ]
Hillel, Alexander T. [18 ]
Hoffman, Henry T. [19 ]
Hogikyan, Norman D. [20 ]
Howell, Rebecca J. [12 ]
Huang, Li-Ching [2 ]
Hussain, Lena K. [2 ]
Johns, Michael M., III [21 ]
Kasperbauer, Jan L. [15 ]
Khosla, Sid M. [12 ]
Kinnard, Cheryl [1 ]
Kupfer, Robbi A. [20 ]
Langerman, Alexander J. [1 ]
Lentz, Robert J. [22 ]
Lorenz, Robert R. [5 ]
Lott, David G. [23 ]
Lowery, Anne S. [1 ]
Makani, Samir S. [24 ]
Maldonado, Fabien [22 ]
Mannion, Kyle [1 ]
Matrka, Laura [25 ]
McWhorter, Andrew J. [26 ]
Merati, Albert L. [27 ]
Mori, Matthew C. [28 ]
Netterville, James L. [1 ]
O'Dell, Karla [21 ]
Ongkasuwan, Julina [13 ]
机构
[1] Vanderbilt Univ, Med Ctr, Dept Otolaryngol Head & Neck Surg, Med Ctr East,Ste 7302,1215 21st Ave S, Nashville, TN 37232 USA
[2] Vanderbilt Ingram Canc Ctr, Vanderbilt Ctr Quantitat Sci, Nashville, TN USA
[3] NYU, Sch Med, Dept Otolaryngol Head & Neck Surg, Voice Ctr, New York, NY USA
[4] Cleveland Clin, Head & Neck Inst, Dept Otolaryngol Head & Neck Surg, Cleveland, OH 44106 USA
[5] Med Coll Wisconsin, Dept Otolaryngol & Commun Sci, Div Laryngol & Profess Voice, Milwaukee, WI 53226 USA
[6] Univ Alabama Birmingham, Dept Surg, Div Otolaryngol, Birmingham, AL 35294 USA
[7] Univ Colorado, Sch Med, Dept Otolaryngol Head & Neck Surg, Denver, CO USA
[8] Duke Univ, Med Ctr, Duke Voice Care Ctr, Div Otolaryngol Head & Neck Surg, Durham, NC USA
[9] Loma Linda Univ Hlth, Dept Otolaryngol Head & Neck Surg, Loma Linda, CA USA
[10] Univ Wisconsin Hosp & Clin, Dept Surg, Madison, WI 53792 USA
[11] Univ Virginia Hlth Syst, Dept Otolaryngol Head & Neck Surg, Charlottesville, VA USA
[12] Univ Cincinnati, Dept Otolaryngol Head & Neck Surg, Cincinnati, OH USA
[13] Baylor Coll Med, Dept Otolaryngol Head & Neck Surg, Houston, TX 77030 USA
[14] Mayo Clin, Div Pulm & Crit Care Med, Rochester, MN USA
[15] Mayo Clin, Coll Med & Sci, Dept Otolaryngol, Rochester, MN USA
[16] Massachusetts Eye & Ear Infirm, Dept Otolaryngol Head & Neck Surg, Boston, MA 02114 USA
[17] Univ Maryland, Sch Med, Dept Otorhinolaryngol Head & Neck Surg, Baltimore, MD 21201 USA
[18] Johns Hopkins Med Inst, Dept Otolaryngol Head & Neck Surg, Baltimore, MD 21205 USA
[19] Univ Iowa Hosp & Clin, Dept Otolaryngol Head & Neck Surg, Iowa City, IA 52242 USA
[20] Univ Michigan, Med Ctr, Dept Otolaryngol Head & Neck Surg, Ann Arbor, MI 48109 USA
[21] Univ Southern Calif, Dept Otolaryngol Head & Neck Surg, Los Angeles, CA 90007 USA
[22] Vanderbilt Univ, Med Ctr, Div Allergy Pulm & Crit Care Med, Nashville, TN USA
[23] Mayo Clin, Dept Otorhinolaryngol, Scottsdale, AZ USA
[24] Univ Calif San Diego, Div Pulm & Crit Care Med, San Diego, CA 92103 USA
[25] Ohio State Univ, Med Ctr, Dept Otolaryngol Head & Neck Surg, Columbus, OH 43210 USA
[26] Louisiana State Univ, Hlth Sci Ctr New Orleans, Dept Otolaryngol, New Orleans, LA USA
[27] Univ Washington, Med Ctr, Dept Otolaryngol Head & Neck Surg, Seattle, WA 98195 USA
[28] New York Eye & Ear Infirm Mt Sinai, Dept Otolaryngol, New York, NY USA
[29] Augusta Univ, Med Coll Georgia, Dept Otolaryngol Head & Neck Surg, Augusta, GA USA
[30] Bastian Voice Inst, Downers Grove, IL USA
[31] Univ Calif San Francisco, Dept Otolaryngol Head & Neck Surg, San Francisco, CA USA
[32] Imperial Coll Healthcare Natl Hlth Syst Trust, Charing Cross Hosp, Natl Ctr Airway Reconstruct, London, England
[33] Oregon Hlth & Sci Univ, Northwest Clin Voice & Swallowing, Dept Otolaryngol Head & Neck Surg, Portland, OR 97201 USA
[34] Univ Rochester, Dept Otolaryngol, Rochester, NY USA
[35] Univ N Carolina, Dept Otolaryngol Head & Neck Surg, Chapel Hill, NC 27515 USA
[36] Univ Utah, Div Otolaryngol Head & Neck Surg, Salt Lake City, UT USA
[37] Univ Pittsburgh, Dept Otolaryngol Head & Neck Surg, Pittsburgh, PA USA
[38] Temple Univ, Lewis Katz Sch Med, Dept Otolaryngol Head & Neck Surg, Philadelphia, PA 19122 USA
[39] Landspitali Univ Hosp, Reykjavik, Iceland
[40] Royal North Shore Hosp, Dept Otolaryngol Head & Neck Surg, Sydney, NSW, Australia
[41] Univ Calif Irvine, Dept Otolaryngol Head & Neck Surg, Irvine, CA USA
[42] Louisiana State Univ, Dept Otolaryngol, Feist Weiller Canc Ctr, Shreveport, LA 71105 USA
[43] Louisiana State Univ, Dept Mol Physiol, Feist Weiller Canc Ctr, Shreveport, LA 71105 USA
[44] Louisiana State Univ, Dept Cellular Physiol, Feist Weiller Canc Ctr, Shreveport, LA 71105 USA
[45] Univ Calif San Diego, Dept Surg, Div Otolaryngol Head & Neck Surg, San Diego, CA 92103 USA
关键词
RELIABILITY; VALIDATION;
D O I
10.1001/jamaoto.2019.3022
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
This cohort study of 810 patients with idiopathic subglottic stenosis compares the outcomes of the 3 most common surgical treatment procedures: endoscopic dilation, endoscopic resection with adjuvant medication, or cricotracheal resection. Question What are the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS)? Findings In this cohort study of 810 patients with iSGS who underwent 1 of the 3 most common surgical treatments, 23% of patients underwent a recurrent surgical procedure during the 3-year study period, but recurrence differed by modality (cricotracheal resection, 1%; endoscopic resection with adjuvant medical therapy, 12%; and endoscopic dilation, 28%). Among successfully treated patients, those who underwent cricotracheal resection reported the highest quality of life but the greatest perioperative risk and worst long-term voice outcomes. Meaning These results show the feasibility of integrating an engaged rare disease community with a network of surgeons to facilitate rapid and nuanced treatment comparisons; findings may help inform treatment decision-making in iSGS. Importance Surgical treatment comparisons in rare diseases are difficult secondary to the geographic distribution of patients. Fortunately, emerging technologies offer promise to reduce these barriers for research. Objective To prospectively compare the outcomes of the 3 most common surgical approaches for idiopathic subglottic stenosis (iSGS), a rare airway disease. Design, Setting, and Participants In this international, prospective, 3-year multicenter cohort study, 810 patients with untreated, newly diagnosed, or previously treated iSGS were enrolled after undergoing a surgical procedure (endoscopic dilation [ED], endoscopic resection with adjuvant medical therapy [ERMT], or cricotracheal resection [CTR]). Patients were recruited from clinician practices in the North American Airway Collaborative and an online iSGS community on Facebook. Main Outcomes and Measures The primary end point was days from initial surgical procedure to recurrent surgical procedure. Secondary end points included quality of life using the Clinical COPD (chronic obstructive pulmonary disease) Questionnaire (CCQ), Voice Handicap Index-10 (VHI-10), Eating Assessment Test-10 (EAT-10), the 12-Item Short-Form Version 2 (SF-12v2), and postoperative complications. Results Of 810 patients in this cohort, 798 (98.5%) were female and 787 (97.2%) were white, with a median age of 50 years (interquartile range, 43-58 years). Index surgical procedures were ED (n = 603; 74.4%), ERMT (n = 121; 14.9%), and CTR (n = 86; 10.6%). Overall, 185 patients (22.8%) had a recurrent surgical procedure during the 3-year study, but recurrence differed by modality (CTR, 1 patient [1.2%]; ERMT, 15 [12.4%]; and ED, 169 [28.0%]). Weighted, propensity score-matched, Cox proportional hazards regression models showed ED was inferior to ERMT (hazard ratio [HR], 3.16; 95% CI, 1.8-5.5). Among successfully treated patients without recurrence, those treated with CTR had the best CCQ (0.75 points) and SF-12v2 (54 points) scores and worst VHI-10 score (13 points) 360 days after enrollment as well as the greatest perioperative risk. Conclusions and Relevance In this cohort study of 810 patients with iSGS, endoscopic dilation, the most popular surgical approach for iSGS, was associated with a higher recurrence rate compared with other procedures. Cricotracheal resection offered the most durable results but showed the greatest perioperative risk and the worst long-term voice outcomes. Endoscopic resection with medical therapy was associated with better disease control compared with ED and had minimal association with vocal function. These results may be used to inform individual patient treatment decision-making.
引用
收藏
页码:20 / 29
页数:10
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