{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T15:08:42Z","timestamp":1784819322697,"version":"3.55.0"},"reference-count":59,"publisher":"Wiley","license":[{"start":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T00:00:00Z","timestamp":1723593600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To critically evaluate oncological and functional outcomes following transoral laser microsurgery (TLM) in patients with T3\/T4a glottic and supraglottic squamous cell carcinoma (SCC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p>A comprehensive search of five major databases\u2014PubMed, Embase, Scopus, ScienceDirect, and Web of Science\u2014was conducted using a combination of relevant keywords and MeSH terms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Review Methods<\/jats:title><jats:p>Systematic review and meta\u2010analysis of odds ratio (OR), hazards ratio (HR), and proportion, focusing on oncological and functional outcomes of TLM in advanced T3\/T4a glottic and supraglottic tumors. A random\u2010effects meta\u2010analysis model was employed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The review incorporated 29 cohort studies, representing a total of 1,897 patients undergoing TLM for T3\/T4a glottic and supraglottic SCC. The cumulative 5\u2010year disease\u2010free survival (DFS) rate for T3 glottic and supraglottic tumors was 44.4% (95% CI: 47\u201366%) and 62.8% (95% CI: 63\u201381%), while the 5\u2010year DFS for T4 glottic and supraglottic tumors was 41.1% (95% CI: 33.4\u201349.2%) and 32.9% (95% CI: 19.3\u201350.1%), respectively. T3 glottic tumors exhibited a 2.5\u2010fold significantly higher odds of local recurrence post\u2010TLM compared to their T3 supraglottic tumors (95% CI: 1.6\u20133.9, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). Laryngeal preservation rates for T3glottic and supraglottic tumors were 68.9% (95% CI: 48.7\u201383.8%) and 88.4% (95% CI: 79.4\u201393.8%), respectively. Both groups showed comparable rates of tracheostomy (<jats:italic>p<\/jats:italic>\u2009=\u20090.48) and gastrostomy performed (<jats:italic>p<\/jats:italic>\u2009=\u20090.17).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This meta\u2010analysis suggests that TLM is a viable larynx preservation approach in select patients with T3\/T4a glottic and supraglottic tumors. However, glottic tumors may have less favorable outcomes after TLM compared to those with advanced supraglottic tumors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>N\/A Laryngoscope, 2024 <jats:italic>Laryngoscope<\/jats:italic>, 2024<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.31695","type":"journal-article","created":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T09:29:51Z","timestamp":1723627791000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Survival Outcomes of Transoral Microsurgery in <scp>T3<\/scp>\/T4a Laryngeal Tumors: Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6998-1658","authenticated-orcid":false,"given":"Srivatsa Surya","family":"Vasudevan","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Louisiana State University Health Sciences Center  Shreveport Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Zulli","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Louisiana State University Health Sciences Center  Shreveport Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Olinde","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Louisiana State University Health Sciences Center  Shreveport Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4952-6711","authenticated-orcid":false,"given":"John","family":"Pang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Louisiana State University Health Sciences Center  Shreveport Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7386-318X","authenticated-orcid":false,"given":"Cherie\u2010Ann O.","family":"Nathan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Louisiana State University Health Sciences Center  Shreveport Louisiana USA"},{"name":"Department of Surgery Overton Brooks Veterans Administration Medical Center  Shreveport Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9028-8746","authenticated-orcid":false,"given":"Ameya A.","family":"Asarkar","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Louisiana State University Health Sciences Center  Shreveport Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,14]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000236095.97947.26"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2011.171"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa031317"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199106133242402"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.14.8841"},{"issue":"12","key":"e_1_2_6_9_1","first-page":"681","article-title":"Crico\u2010hyoido\u2010epiglotto\u2010pexy. 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