Abstract: Objective To investigate the clinical features and anesthetic concerns of pulmonary dissemination in juvenile-onset recurrent respiratory papillomatosis(JORRP). Methods We retrospectively analysed the clinical medical records of 120 children with JORRP who attended Beijing Tongren Hospital, Capital Medical University, from 1 June 2022 to 31 December 2023, defined those who showed special signs on lung CT as pulmonary dissemination, and compared the differences in clinical features and general anesthetic concerns between the pulmonary dissemination group and the no-dissemination group. Results The incidence of JORRP pulmonary dissemination in this study was 15.8%(19/120), with imaging findings of scattered nodules of variable size and round cavities in the lungs. The age of initial surgery in the pulmonary dissemination group was younger than that in the no-dissemination group ［1.4(0.9-2.4)years vs. 2.7(1.7-4.7)years］, and the total number of surgeries was greater than that in the no-dissemination group ［32.0(19.0-46.0)times vs. 13.0(4.0-24.0)times］. The tracheotomy rate, the tracheal dissemination rate and the incidence of atypical hyperplasia in the pulmonary dissemination group were significantly higher than those in the no-dissemination group(78.9% vs. 10.9%, 100.0% vs. 11.9%, 68.4% vs. 27.7%). The differences in the incidence of preoperative pneumonia, duration of surgery, duration of general anesthesia, duration of recovery from anesthesia, and ICU retention rate were statistically significant(P<0.05). Multifactorial Logistic regression analysis showed that age at first presentation ≤2.5 years, tracheotomy, atypical hyperplasia and higher number of operations(OR>1, P<0.05)were risk factors for pulmonary dissemination. Multivariate Logistic regression analysis showed that age at onset≤2.5 years, tracheotomy, atypical hyperplasia and frequent surgery(OR>1, P<0.05)were risk factors for pulmonary dissemination. Conclusion Compared to general JORRP patients, JORRP patients with pulmonary dissemination have a younger initial age of surgery, more surgeries, a higher tracheotomy rate, a higher incidence of preoperative pneumonia, a longer operation and general anaesthesia time, a higher ICU observation rate and a poorer prognosis. Children with JORRP who have a history of tracheotomy and atypical hyperplasia with an initial age of onset ≤2.5 years should be alert for pulmonary dissemination of the papilloma and undergo regular lung CT screening.

Key words: Juvenile-onset recurrent respiratory papillomatosis, Human papilloma virus, Tracheal dissemination, Pulmonary dissemination, Anesthesia