Clinical Characteristics and Risk Factors for Major Complications in Recurrent Respiratory Papillomatosis: A Single-Institution Retrospective Study

Background and Objectives Recurrent respiratory papillomatosis (RRP) is a rare HPVassociated disease characterized by recurrent papillomatous lesions within the airway.Subjects and Method We retrospectively analyzed 165 patients who were treated for RRP at a single tertiary institution between 2005 and 2021 and evaluated clinical characteristics, treatment outcomes, and risk factors for major complications.Results Juvenile-onset RRP (JO-RRP) accounted for 11.5% of the cases, demonstrating a significantly more aggressive clinical course than adult-onset RRP (AO-RRP). JO-RRP patients showed markedly higher rates of subglottic spread, tracheotomy, and laryngeal stenosis, while no cases achieved remission. CO2, PDL, and KTP lasers were used for surgical treatment, often combined with intralesional cidofovir injection and HPV vaccination. Our findings suggest that JO-RRP is associated with poor prognosis and aggressive airway involvement. Tracheotomy and repeated surgeries are highly likely to serve as indicators reflecting disease severity, a prolonged disease course, lower respiratory tract involvement, and airway obstruction.Conclusion These findings suggest that continuous surveillance for complications is essential in patients with a high disease burden.