The aim of this Italian systematic review was to establish outcomes (local control and survival) of conservative laryngeal surgery for advanced T stage laryngeal cancers. Articles published from 1980 onwards, had at least 10 patients that underwent partial laryngeal surgery (open or transoral laser) and with a minimum of a five year follow-up were included. The authors performed a robust search strategy and exclusion process yielding 21 studies that were included in the meta-analysis.
A total of 1918 patients, (1448 with T3 and 470 T4) were analysed. The pooled disease-free five-year survival for these patients was 79% with laryngeal preservation rate of 80%. Survival outcomes from both open and closed techniques were comparable.
There was significant heterogeneity between the studies due to multiple permutations of surgical procedures and disease staging. The current UK cancer head and neck guidelines recommends the consideration of transoral laser surgery, open partial laryngeal surgery and chemoradiotherapy as primary treatment modalities for the T3 larynx. The choice of treatment depends on laryngeal function, institutional expertise and most importantly patient choice. The quality of life outcomes were not examined and treatment modalities were not compared with primary chemoradiotherapy. However, in the context of survival, it does give further evidence for the support of conservative surgical procedures for advanced laryngeal cancer.