BACKGROUND: Vocal cord leukoplakia is a precancerous lesion for which early surgical intervention following ineffective conservative treatment is the predominant approach. Carbon dioxide (CO2) laser treatment is a novel, minimally invasive therapy. However, there is insufficient evidence to suggest that CO2 laser treatment is superior to conventional surgical methods in terms of efficacy and safety. Therefore, this meta-analysis aimed to evaluate the efficacy and safety of CO2 laser treatment vs conventional surgical treatment for vocal cord leukoplakia. METHODS: A literature search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across 8 databases. Studies on the use of carbon dioxide laser therapy for vocal cord leukoplakia were included in the review. Two researchers conducted a systematic search for randomized controlled trials in PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure, Wanfang, Chinese Science and Technology Periodical Database, and Chinese Biomedical Literature databases. Meta-analysis was performed using Stata 18.0, and RevMan 5.2 software. RESULTS: The findings indicated that Compared with conventional surgery, CO2 laser surgery significantly reduced the recurrence rate of vocal cord leukoplakia (odds ratio [OR] = 0.25, 95% confidence interval, CI [0.12, 0.51]). CO2 laser surgery significantly improved the cure rate of vocal cord leukoplakia (OR = 3.07, 95% CI [1.17, 8.09]). Voice quality following CO2 laser surgery was significantly superior to that following conventional surgery, particularly in terms of fundamental frequency disturbance (standardized mean difference [SMD] = -0.8, 95% CI [-1.25, -0.34]) and amplitude disturbance (SMD = -0.52, 95% CI [-0.95, -0.09]). The CO2 laser group exhibited a lower incidence of postoperative adverse reactions (OR = 0.32, 95% CI [0.03, 3.19])
however, this difference was not statistically significant. CONCLUSION: The results of this meta-analysis suggest that CO2 laser surgery can reduce the recurrence rate of vocal cord leukoplakia, improve the cure rate, and enhance voice quality. Therefore, CO2 laser surgery is recommended as a minimally invasive surgical approach for vocal cord leukoplakia.