Total laryngectomy vs. non-surgical organ preservation in advanced laryngeal cancer: a metanalysis

Abstract

Objective

To compare the oncological results and the functional outcomes of patients undergoing Total Laryngectomy (TL) with the non-surgical treatment (organ preservation protocol) in the treatment of advanced laryngeal carcinomas through systematic review and meta-analysis.

Methods

A literature survey strategy was employed in order to perform a systematic review of the available evidence. Success rate and functional outomes after oncological treatment of patients with advanced laryngeal carcinomas was evaluated through systematic review and metanalysis, comparing TL and organ preservation protocol.

Results

The surgical treatment was associated with better survival outcomes. When stratifying by T stage, while patients with T4 staging have less risk of mortality with TL, there is no difference between the different treatments for patients with T3 tumors. Surgery is related to a lower chance of recurrence, late dysphagia and feeding tube dependence.

Conclusion

Patients with T4 tumors should undergo TL as their treatment of choice. For patients with T3 tumors, there is no differences on the risk of mortality according to the therapeutic option, however, there is a greater chance of recurrence and dysphagia when surgery is not performed.

Keywords
Laryngectomy; Organ preservation treatment; Metanalysis; Larynx cancer

Highlights

Patients with advanced laryngeal SCC have better surviving rates when submitted to TL as the first-choice treatment.

Patients with T4 tumors should have TL as their treatment of choice.

T3 tumors have similar survival rates with both treatments. Higher recurrence and worse disease-free survival with NST.

Dysphagia and feeding tube dependence are more likely to happen when using organ preservation treatment.