Surgical management of T4a supraglottic carcinoma: considerations on the updated NCCN guidelines

The 2026 NCCN Guidelines for supraglottic laryngeal carcinoma introduce a potential inconsistency in the surgical management of advanced disease. While total laryngectomy is explicitly recommended for T3 tumors, it is not clearly included in the T4a supraglottic pathway, where only endoscopic or open partial laryngectomy is reported. Given that T4a disease involves cartilage invasion and/or extralaryngeal extension, and that total laryngectomy remains a standard treatment in this setting, this omission may generate confusion and deviate from established oncologic principles. Clarification is warranted to ensure alignment with current standards of care.