Oncologic Outcomes of Total Laryngectomy in Comparison With Organ-Preservation Treatment for Locally Advanced Laryngeal Cancer: Systematic Review and Meta-Analysis by the Korean Society of Head and Neck Surgery Guidelines Taskforce

Background and Objectives Treating advanced laryngeal cancer requires balancing survival with functional preservation. This study meta-analyzed oncologic outcomes to assess the role of total laryngectomy (TL) in managing locally advanced laryngeal cancer. Subjects and Method A meta-analysis of 19 retrospective cohort studies compared TL with organ-preserving treatments, evaluating overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), and locoregional control (LC) to assess oncologic outcomes. Results The study included a total of 26054 patients: 9870 who underwent primary TL and 16184 who received organ-preserving treatments. For OS, TL demonstrated a significantly lower risk compared to organ-preserving treatments (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.66-0.90, p=0.0007). Subgroup analyses were conducted for T3 and T4 stages. In T3 cases, there was no significant difference in risk between the two treatment approaches. However, in T4 cases, organ-preserving treatments showed a significantly higher risk compared to TL (HR 1.40, 95% CI 1.25-1.57, p<0.00001). No significant differences were found between the two treatments for DFS or DSS. For LC, TL was associated with a significantly lower risk of recurrence (HR 0.58, 95% CI 0.38-0.88, p=0.01). Conclusion TL has generally contributed to the improvement of OS in locally-advanced laryngeal cancer. Notably, it demonstrated a significant survival benefit in T4 stage disease; however, this was not observed in T3 stage disease. Treatment decisions should consider tumor stage, patient age, comorbidities, and social activity to ensure a balanced strategy tailored to individual patients and tumor characteristics.