The Influence of Surgical Margins on Oncologic Outcomes in Advanced Laryngeal Cancer: A Systematic Review and Meta-analysis

Purpose of review: Surgical margins are a critical factor for oncologic outcomes in head and neck squamous cell carcinoma (SCC), but their significance in advanced laryngeal cancer remains unclear. The objective was to evaluate the impact of surgical margins on survival outcomes in patients undergoing total laryngectomy (TL) for advanced laryngeal SCC.Systematic review and meta-analysis of PubMed, Embase, and Scopus were searched from 1990 to 2025. Eligible studies included randomized clinical trials, prospective, and retrospective cohort studies reporting survival outcomes stratified by surgical margin status in patients undergoing TL. Primary outcome was overall survival (OS). Secondary outcomes included recurrence-free (RFS), disease-free (DFS), and disease-specific survivals (DSS). Methods: PubMed, Embase, and Scopus were searched from 1990 to 2025. Eligible studies included randomized clinical trials, prospective, and retrospective cohort studies reporting survival outcomes stratified by surgical margin status in patients undergoing TL. Primary outcome was overall survival (OS). Recent Findings: A total of 13 studies (n = 2016 patients) were eligible for quantitative synthesis. In the combined cohort of primary and salvage TL, positive margins were associated with significantly worse OS compared with clear margins (HR, 1.87; p < 0.001). In the salvage-only cohort, the adverse effect was more pronounced (HR, 2.05; p < 0.001). For primary TL, the association was not statistically significant (HR, 1.52; p = 0.07). Positive margins also predicted inferior RFS in primary TL (HR, 1.93; p < 0.001). Close margins were not significantly different from clear margins (HR, 1.28; p = 0.33). Summary: Positive surgical margins are associated with significantly worse survival following TL, particularly in salvage cases. Close margins do not appear to confer the same adverse prognostic effect, although trends toward inferior survival were observed. These findings underscore the importance of achieving negative margins whenever feasible, highlight the limitations of current margin definitions in the larynx.