OBJECTIVE: This study describes a large series of patients receiving topical mitomycin-c (MMC) during airway surgery, including complications, and carries out a cost analysis for its use in laryngotracheal stenosis.
STUDY DESIGN AND SETTING: Retrospective review, tertiary center. Airway patients receiving MMC are reviewed for demographics, stenosis characteristics, and MMC usage. A basic cost analysis is carried out.
RESULTS: Fifty patients underwent 93 MMC applications (mean = 50.8 years, 25 male, 25 female). In 89 of 93 applications (96%), the concentration of MMC was 0.4 mg/ml. One major complication occurred (1.1%). The expense for MMC is $455; the mean cost for airway surgery is $7,840. It is estimated that if 1 of 17 MMC treated patients requires one less operation, the cost ratio is favorable.
CONCLUSIONS: This large series contributes to literature that MMC is a safe adjunct to laryngotracheal surgery. The marginal cost for MMC application is favorable based on our basic cost analysis and existing efficacy data.
SIGNIFICANCE: Mitomycin-c seems to be safe and cost-effective in endoscopic airway surgery.
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References
1.
GrilloHC. The history of tracheal surgery.Chest Surg Clin N Am2003;13:175–89
2.
CampbellBHDennisonBFDurkinGE. Early and late dilatation for acquired subglottic stenosis.Otolaryngol Head Neck Surg1986;95:566–73
3.
OssoffRHTuckerGFDuncavageJA. Efficacy of bronchoscopic carbon dioxide laser surgery for benign strictures of the trachea.Laryngoscope1985;95:1220–3
4.
SimpsonGTStrongMSHealyGB. Predictive factors of success or failure in the endoscopic management of laryngeal and tracheal stenosis.Ann Otol Rhinol Laryngol1982;91:384–8
5.
ShapshaySMBeamisJFHybelsRL. Endoscopic treatment of subglottic and tracheal stenosis by radial laser incision and dilation.Ann Otol Rhinol Laryngol1987;96:661–4
6.
JampelHD. Effect of brief exposure to mitomycin-c on viability and proliferation of cultured human Tenon's capsule fibroblasts.Ophthalmology1992;99:1471–6
7.
KhawPTSherwoodMBMacKaySL. Five-minute treatments with fluorouracil, floxuridine, and mitomycin have long-term effects on human Tenon's capsule fibroblasts.Arch Ophthalmol1992;110:1150–4
8.
LeeDALeeTCCortesAE. Effects of mitramycin, mitomycin, daunorubicin and bleomycin on human subconjunctival fibroblasts attachment and proliferation.Invest Ophthalmol Vis Sci1990;31:2136–44
9.
Frucht-PeryJSiganosCSIlsarM. Intraoperative application of topical mitomycin c for pterygium surgery.Ophthalmology1996;103:674–7
10.
SugarA. Who should receive mitomycin-c after pterygium surgery?Ophthalmology1992;99:1645–6
11.
EstremSABatraPS. Preventing myringotomy closure with topical mitomycin C in rats.Otolaryngol Head Neck Surg1999;120:794–8
12.
IngramsDRVolkMSBiesmanBS. Sinus surgery: Does mitomycin C reduce stenosis?Laryngoscope1998;108:883–6
13.
SpectorJEWerkhavenJASpectorNC. Preservation of function and histologic appearance in the injured glottis with topical mitomycin-c.Laryngoscope1999;109:1125–9
14.
SpectorJEWerkhavenJASpectorNC. Prevention of anterior glottic restenosis in a canine model with topical mitomycin-c.Ann Otol Rhinol Laryngol2001;110:1007–10
15.
GarrettCGSotoJRiddickJ. Effect of mitomycin-c on vocal fold healing in a canine model.Ann Otol Rhinol Laryngol2001;110:25–30
16.
EliasharREliacharIEsclamadoR. Can topical mitomycin prevent laryngotracheal stenosis?Laryngoscope1999;109:1594–600
17.
CorreaAJReinischLSandersDL. Inhibition of subglottic stenosis with mitomycin-c in the canine model.Ann Otol Rhinol Laryngol1999;108:1053–60
18.
RahbarRShapshaySMHealyGB. Mitomycin: Effects on laryngeal and tracheal stenosis, benefits, and complications.Ann Otol Rhino Laryngol2001;110:1–6
19.
PerepelitsynIIShapshaySM. Endoscopic treatment of laryngeal and tracheal stenosis—has mitomycin C improved the outcome?Otolaryngol Head Neck Surg2004;131:16–20
20.
HuemanEMSimpsonCB. Airway complications from topical mitomycin-c.Otolaryngol Head Neck Surg2005;133:831–5
