Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Sep 18.
doi: 10.1007/s00405-025-09647-8. Online ahead of print.

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

Rami Saade  1 , Caroline Jabbour  2 , Elias Keyrouz  3 , Jana Hassan  3 , Bassel El Baba  3 , Anita El Hajj  4 , Hady Ghanem  5
Affiliations
Review

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

Rami Saade et al. Eur Arch Otorhinolaryngol. .

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Laryngeal cancer; Pharyngocutaneous fistula; Primary total laryngectomy; Salvage total laryngectomy; Tracheoesophageal voice prosthesis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval: Not applicable. Competing interests: The authors have no relevant financial or non-financial interests to disclose.

References

    1. Deng Y, Wang M, Zhou L, Zheng Y, Li N, Tian T et al (2020) Global burden of larynx cancer, 1990–2017: estimates from the global burden of disease 2017 study. Aging 12(3):2545 - DOI - PubMed - PMC
    1. Ceachir O, Hainarosie R, Zainea V (2014) Total laryngectomy–past, present, future. Maedica 9(2):210 - PubMed - PMC
    1. Tsetsos N, Poutoglidis A, Vlachtsis K, Stavrakas M, Nikolaou A, Fyrmpas G (2021) Twenty-year experience with salvage total laryngectomy: lessons learned. J Laryngol Otol 135(8):729–736 - DOI - PubMed
    1. Agrawal N, Goldenberg D (2008) Primary and salvage total laryngectomy. Otolaryngol Clin North Am 41(4):771–780 - DOI - PubMed
    1. Chen AY, Fedewa S, Zhu J (2011) Temporal trends in the treatment of early-and advanced-stage laryngeal cancer in the united states, 1985–2007. Arch Otolaryngol Head Neck Surg 137(10):1017–1024 - DOI - PubMed

LinkOut - more resources