Prognostic significance of surgical margins in laryngeal cancer treated by transoral laser microsurgery: a systematic review and meta-analysis

Objective. To evaluate the prognostic significance of surgical margins in patients undergoing transoral laser microsurgery (TLM) for laryngeal squamous cell carcinoma (LSCC). Methods. A comprehensive literature search was conducted in PubMed/MEDLINE, Cochrane Library, Scopus, and Google Scholar following PRISMA guidelines. Studies comparing oncologic outcomes between positive and negative resection margins were included. Hazard ratios (HRs) for local control (LC), disease-free survival (DFS), and overall survival (OS) were extracted and pooled using a random-effects model to account for inter-study variability. Results. A total of 26 studies, including 5,463 patients, met inclusion criteria. The pooled log-HR for DFS was 0.93 (p < 0.05), indicating a significantly higher risk of recurrence in patients with positive margins. However, no significant differences were observed for LC (log-HR =-0.76, p = 0.59) or OS (log-HR = 0.16, p = 0.40). Conclusions. While positive surgical margins significantly impact DFS, their effect on LC and OS remains uncertain. Further prospective studies are necessary to refine treatment guidelines and optimise oncologic outcomes.