Prognostic significance of surgical margins in open neck horizontal laryngectomy: a systematic review and meta-analysis.

Objective: Over the past two decades there has been a strategic shift in treating laryngeal cancer, with an increasing emphasis on preserving the anatomical structure and function of the larynx, even in cases of intermediate or advanced stages of disease. Open partial horizontal laryngectomies (OPHL) are widely adopted to spare the physiological functions of the larynx while achieving good oncological control. Positive, close or narrow surgical margins remain a critical prognostic factor, with their impact varying by tumour location and laryngeal subsite. This review examines the influence of positive margins on survival and the potential need for adjuvant treatments to optimise functional and oncological outcomes.

Methods: This study adhered to PRISMA guidelines. Using the PICOS framework, it included studies on adults with laryngeal squamous cell carcinoma treated by OPHL, focusing on survival and local control outcomes. A systematic search of PubMed, EMBASE, and Cochrane databases from 2000 to 2023 was conducted and eligible studies were selected based on comprehensive inclusion criteria and screening of references.

Results: The initial search yielded 675 articles from PubMed, 799 from EMBASE, and 33 from the Cochrane Library. After exclusions and duplicate removal, 57 full-text articles were reviewed, with 8 included for qualitative analysis and 7 for quantitative analysis. A total of 2,715 patients (age range, 16-87 years) were recruited across studies spanning from 2001 to 2021, all of which were retrospective. Among patients, 284 (10%) received neoadjuvant treatment and 627 (23%) underwent adjuvant therapy for positive margins, lymph node involvement and adverse pathological features. Seven studies assessed the association between margin status and recurrence, showing that close/positive margins significantly increased recurrence risk (OR 2.77, 95% CI 1.99-3.87, p < 0.01), with no publication bias detected.

Conclusions: This review highlights the challenges in defining and managing resection margins in OPHL for laryngeal cancer. While positive or close margins increase the risk of local recurrence, their effect on overall survival is unclear, emphasising the need for standardised protocols and individualised, multidisciplinary treatment planning.