Abstract
BACKGROUND: Granulation tissue formation complicates laryngeal cancer surgery recovery and may be exacerbated by laryngopharyngeal reflux. We investigated whether postoperative proton pump inhibitor (PPI) therapy reduces granulation tissue duration through reflux-mediated mechanisms. METHODS: This retrospective cohort study included 89 laryngeal cancer patients undergoing function-preserving surgery (May 2020-December 2024). Patients received either postoperative PPI therapy (n=32) or standard care (n=57). Primary endpoint was granulation tissue duration. Secondary endpoints included Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) changes. Mediation analysis explored whether PPI effects operated through reflux improvement. RESULTS: Granulation formation rates were comparable between groups (65.6% vs 57.9%, P=0.188). Among patients developing granulation tissue (n=54), the PPI group demonstrated significantly shorter duration (4.0 [4.0, 5.0] vs 8.0 [6.0, 9.0] weeks, P<0.001). PPI therapy produced superior improvements in RSI (14.0 [13.0, 16.0] vs 4.0 [3.0, 4.0], P<0.001) and RFS scores (8.0 [6.8, 9.0] vs 2.0 [1.0, 3.0], P<0.001). Strong negative correlations existed between reflux improvement and granulation duration (RSI: r=-0.76; RFS: r=-0.74, both P<0.001). Mediation analysis revealed RSI improvement accounted for 16.18% of PPI's therapeutic effect. Benefits were most pronounced in females, early-stage tumors, and patients with lower baseline RSI scores. CONCLUSION: Postoperative PPI therapy significantly reduces granulation tissue duration following laryngeal cancer surgery through both reflux-dependent and independent mechanisms, supporting routine perioperative acid suppression in this population.