Prognostic Value of Primary Total Glossectomy in Tongue Cancer: A Systematic Review and Meta-Analysis of Survival Outcomes.

Background/

Objectives

Total glossectomy (TG) is among the most radical operations in head and neck oncology. While it can achieve local control in advanced oral tongue squamous cell carcinoma, survival and functional outcomes are inconsistently reported, and pooled estimates remain limited. This study aimed to systematically evaluate survival, functional recovery, and prognostic factors following primary TG.

Methods

We conducted a proportional meta-analysis of studies reporting outcomes after primary TG for oral tongue squamous cell carcinoma. Studies combining TG with laryngectomy, salvage settings, or second primary tumors were excluded. Two reviewers independently screened, extracted data, and assessed quality with the Newcastle-Ottawa Scale. Pooled 1-, 3-, and 5-year overall survival (OS) with 95% confidence intervals (CIs) was calculated using a random-effects model. Heterogeneity was quantified (Q, τ2, I2), and robustness was assessed with sensitivity analyses. Disease-free survival (DFS) and functional outcomes (swallowing, airway, speech) were narratively summarized due to inconsistent reporting.

Results

Ten studies (1992-2022) comprising 261 patients met the criteria. Pooled OS was 81% (95% CI, 71-90) at 1 year, 55% (95% CI, 41-68) at 3 years, and 47% (95% CI, 27-67) at 5 years, with rising heterogeneity (I2 up to 89%). The post-2000 series showed improved 5-year OS (63%). Adverse prognostic factors included advanced T stage, nodal disease (N+), and positive margins. Functional recovery varied: 15-30% remained gastrostomy-dependent and 20-25% aspirated, while reconstruction and structured rehabilitation improved outcomes.

Conclusions

Survival after TG declines beyond the first year, with under half surviving at 5 years, though modern outcomes appear better. Significant functional morbidity underscores the need for multidisciplinary care. Future biomarker-driven studies should refine patient selection and prognostic assessment.