Ivana Fiz1, Philippe Monnier2, Jan Constantin Koelmel3, Diana Di Dio3, Michele Torre4, Francesco Fiz5,6, Francesco Missale7, Cesare Piazza7, Giorgio Peretti8, Christian Sittel3. 1. Department of Otorhinolaryngology Head and Neck Surgery, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany. ivana.fiz.orl@gmail.com. 2. Airway Unit, Service of Otorhinolaryngology, Lausanne University Hospital, Lausanne, Switzerland. 3. Department of Otorhinolaryngology Head and Neck Surgery, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany. 4. Department of Pediatric Surgery, G. Gaslini Children's Hospital, Genoa, Italy. 5. Nuclear Medicine Unit, Department of Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany. 6. Department of Internal Medicine, University of Genoa, Genoa, Italy. 7. Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy. 8. Department of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Largo R. Benzi 10, 16132, Genoa, Italy.
Abstract
PURPOSE: The European Laryngological Society (ELS) has published a revised classification for benign laryngotracheal stenosis (LTS), based on their degree, longitudinal extension, and associated comorbidities. We retrospectively applied this classification to pediatric patients treated in four referral centers to assess its reliability in predicting surgical outcomes. METHODS: We included 191 pediatric LTS patients treated by segmental resection, restaged according to the degree of stenosis (I-IV according to Myer-Cotton grading system), number of subsites involved ("a" to "d" for 1-4 subsites among supraglottis, glottis, subglottis and trachea), and presence of systemic comorbidity ("+" sign). We analyzed the ability of this scoring system in predicting the rates of decannulation and complications, as well as the number of re-treatments. RESULTS: The mean decannulation rate was 88%; a higher rate was observed in patients without comorbidities (95.7% vs. 78.1%, p < 0.001), with two or fewer vs. three or four subsites involved (89% vs. 72%, p < 0.01), and in those with an ELS score of IIIa+ or less vs. patients with IIIb or more (96% vs. 82%, p < 0.001). Surgical complications were not dependent on the degree of stenosis, but rather on the number of affected subsites (p < 0.05), as well as on the presence of associated comorbidities (RR 7.5, p < 0.01). The number of re-treatments was dependent on length of resection (p < 0.05), stage according to the revised ELS classification (p < 0.001), and presence of surgical complications (RR 17, p < 0.001). CONCLUSIONS: The revised ELS classification system is easy to apply in everyday practice and offers a sound contribution in the decision-making process.
PURPOSE: The European Laryngological Society (ELS) has published a revised classification for benign laryngotracheal stenosis (LTS), based on their degree, longitudinal extension, and associated comorbidities. We retrospectively applied this classification to pediatric patients treated in four referral centers to assess its reliability in predicting surgical outcomes. METHODS: We included 191 pediatric LTS patients treated by segmental resection, restaged according to the degree of stenosis (I-IV according to Myer-Cotton grading system), number of subsites involved ("a" to "d" for 1-4 subsites among supraglottis, glottis, subglottis and trachea), and presence of systemic comorbidity ("+" sign). We analyzed the ability of this scoring system in predicting the rates of decannulation and complications, as well as the number of re-treatments. RESULTS: The mean decannulation rate was 88%; a higher rate was observed in patients without comorbidities (95.7% vs. 78.1%, p < 0.001), with two or fewer vs. three or four subsites involved (89% vs. 72%, p < 0.01), and in those with an ELS score of IIIa+ or less vs. patients with IIIb or more (96% vs. 82%, p < 0.001). Surgical complications were not dependent on the degree of stenosis, but rather on the number of affected subsites (p < 0.05), as well as on the presence of associated comorbidities (RR 7.5, p < 0.01). The number of re-treatments was dependent on length of resection (p < 0.05), stage according to the revised ELS classification (p < 0.001), and presence of surgical complications (RR 17, p < 0.001). CONCLUSIONS: The revised ELS classification system is easy to apply in everyday practice and offers a sound contribution in the decision-making process.
Entities:
Keywords:
Cricotracheal resection; ELS score; Laryngeal stenosis classification; Pediatric laryngotracheal stenosis; Reconstructive airway surgery
Authors: Marta Filauro; Francesco Mazzola; Francesco Missale; Frank Rikki Canevari; Giorgio Peretti Journal: Front Pediatr Date: 2020-01-08 Impact factor: 3.418