TLM, TORS and RT in early supraglottic SCC: a meta-analysis of oncological and functional outcomes

Management of early stage supraglottic squamous cell carcinoma (SCC) evolved with the advent of transoral surgical and new radiation techniques. Current guidelines recommend a single therapeutic modality treatment (either organ-sparing surgery or definitive radiotherapy) yet the optimal approach remains controversial. We conducted a systematic review and meta-analysis to compare long-term (five years) oncological and functional outcomes in early SCC. Two independent reviewers screened the literature available on Pubmed, Embase and Google Scholar (1990-2025). Eligible studies included patients with early SCC (T1-T2/N0-N1/M0), treated with transoral laser microsurgery (TLM), transoral robotic surgery (TORS) or Radiotherapy (RT). A systematic review with comprehensive meta-analysis were performed using RⒸ software. 59 studies were included: 19 RT; 30 TLM, 6 TORS and four on mixed treatment studies. Five-year overall survival favored surgical approaches, particularly TORS, with rates of 78% for TORS, 72% for TLM compared with 55% for RT. Swallowing outcomes and Quality-of-Life (QoL) assessments were heterogeneous and not directly comparable. Available functional data (tracheostomy, gastrostomy and total laryngectomy rates) showed similar results across techniques. Meta-regression analyses adjusting for tumor stage, treatment period and use of adjuvant RT confirmed these findings. TORS and TLM appear to be associated with improved overall survival and comparable functional results compared with 2D/3D RT. Further comparisons of modern (intensity modulated) RT and TORS are needed, based on more robust studies including a larger number of patients. QoL and swallowing data remain limited and heterogeneous, highlighting the need for prospective studies using validated assessment tools, comorbidity analysis and multiple treatment arms.