Factors Influencing Laryngeal Web After Surgery Combined With Photodynamic Therapy in <scp>RRP</scp>

ABSTRACT Objectives To analyze risk factors for Laryngeal Web (LW) formation following CO2 laser surgery combined with topical photodynamic therapy (T‐PDT) in patients with recurrent respiratory papillomatosis (RRP). Methods This retrospective study analyzed RRP patients treated with CO2 laser surgery combined with T‐PDT at a single academic medical center between January 2021 and April 2024. The Cohen grading system was used to assess laryngeal web severity before and after treatment. The Wilcoxon rank‐sum test was performed to compare pre‐ and post‐treatment adhesion scores. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for LW formation, including gender, surgical age, onset age, HPV genotype, lesion distribution (Derkay score), preoperative LW presence, previous surgical history, bilateral involvement, and preoperative bevacizumab treatment within 1 month. Results A total of 86 RRP patients received CO2 laser surgery combined with T‐PDT treatment. Post‐treatment LW occurred in 23.26% (20/86) of patients. No significant difference was observed in Cohen grading distribution between pre‐ and post‐treatment groups ( W = 226.5, p = 0.934). Multivariate analysis identified preoperative LW presence (OR = 8.81, p &lt; 0.001) as an independent risk factor for post‐treatment LW formation, whereas preoperative bevacizumab treatment was associated with a lower risk of LW formation (OR = 0.16, p = 0.022). Conclusion CO2 laser surgery combined with T‐PDT demonstrated a relatively low incidence of LW formation in RRP treatment. Preoperative LW presence significantly increased the risk of post‐treatment LW formation, while preoperative bevacizumab treatment was associated with a lower risk of LW formation. Level of Evidence 3.