Survival and larynx function after upfront vs. salvage total laryngectomy: a meta-analysis

Laryngeal cancer is a major malignancy in head and neck oncology, with total laryngectomy (TL) as a key intervention for advanced and recurrent disease. This systematic review and meta-analysis compare primary total laryngectomy (PTL) and salvage total laryngectomy (STL) in survival, functional outcomes, and complications.

A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar was conducted up to January 18, 2025. Studies comparing PTL and STL were included based on predefined eligibility criteria. Data extraction and quality assessment were performed independently by two reviewers. Random-effects models were used to calculate pooled odds ratios (ORs) and mean differences (MDs), with heterogeneity assessed via I² statistics. Sensitivity analyses ensured result robustness.

Thirteen studies (2,704 patients: 913 STL, 1,791 PTL) met inclusion criteria. PTL showed significantly higher overall survival at 1 year (OR = 2.21; 95% CI: 1.38-3.55), 2 years (OR = 1.95; 95% CI: 1.40-2.71), and 3 years (OR = 1.64; 95% CI: 1.10-2.47). STL had higher risks of pharyngocutaneous fistula (OR = 2.78; 95% CI: 1.96-3.95) and reconstructive surgery (OR = 0.11; 95% CI: 0.02-0.75). PTL significantly reduced swallowing difficulty (OR = 0.12; 95% CI: 0.05-0.28) and hypopharyngeal stricture (OR = 0.14; 95% CI: 0.04-0.49). Speech functional outcomes showed no significant differences.

PTL improves survival and swallowing function with fewer complications, making it a preferred upfront treatment. STL remains essential for managing failures. Early identification of high-risk patients may improve clinical decision-making, optimizing survival and functional outcomes.