Survival Outcomes of Transoral Microsurgery in T3/T4a Laryngeal Tumors: Systematic Review and Meta‐Analysis

Abstract

ObjectiveTo critically evaluate oncological and functional outcomes following transoral laser microsurgery (TLM) in patients with T3/T4a glottic and supraglottic squamous cell carcinoma (SCC).Data SourcesA comprehensive search of five major databases—PubMed, Embase, Scopus, ScienceDirect, and Web of Science—was conducted using a combination of relevant keywords and MeSH terms.Review MethodsSystematic review and meta‐analysis of odds ratio (OR), hazards ratio (HR), and proportion, focusing on oncological and functional outcomes of TLM in advanced T3/T4a glottic and supraglottic tumors. A random‐effects meta‐analysis model was employed.ResultsThe review incorporated 29 cohort studies, representing a total of 1,897 patients undergoing TLM for T3/T4a glottic and supraglottic SCC. The cumulative 5‐year disease‐free survival (DFS) rate for T3 glottic and supraglottic tumors was 44.4% (95% CI: 47–66%) and 62.8% (95% CI: 63–81%), while the 5‐year DFS for T4 glottic and supraglottic tumors was 41.1% (95% CI: 33.4–49.2%) and 32.9% (95% CI: 19.3–50.1%), respectively. T3 glottic tumors exhibited a 2.5‐fold significantly higher odds of local recurrence post‐TLM compared to their T3 supraglottic tumors (95% CI: 1.6–3.9, p < 0.0001). Laryngeal preservation rates for T3glottic and supraglottic tumors were 68.9% (95% CI: 48.7–83.8%) and 88.4% (95% CI: 79.4–93.8%), respectively. Both groups showed comparable rates of tracheostomy (p = 0.48) and gastrostomy performed (p = 0.17).ConclusionsThis meta‐analysis suggests that TLM is a viable larynx preservation approach in select patients with T3/T4a glottic and supraglottic tumors. However, glottic tumors may have less favorable outcomes after TLM compared to those with advanced supraglottic tumors.Level of EvidenceN/A Laryngoscope, 2024 Laryngoscope, 2024