BACKGROUND: Transoral laser microsurgery has been suggested as an alternative treatment modality for hypopharyngeal carcinoma. The purpose of this study is to systematically review the oncologic and functional outcomes of patients with hypopharyngeal carcinoma when treated with primary transoral laser microsurgery. METHODS: A comprehensive literature search was performed using PRISMA methodology on OVID MEDLINE and EMBASE. Meta-analysis was completed for oncological outcomes. RESULTS: Six studies reported quality of life outcomes five reported oncologic outcomes. A median of 95% (range 0.83-0.98) patients achieving gastrostomy independence, a median of 3% (range 0%-6%) were tracheostomy dependent, and a median of 97% (Range 0.89-1.0) were able to preserve their larynx. Pooled five-year overall survival was 54% (CI, 0.50-0.58, I = 29%), pooled disease-specific survival was 72% (CI, 0.68-0.77, I = 46%), and pooled local control rate was 78% (CI, 0.72-0.85, I = 69%). CONCLUSION: Systematic review supports improvements in functional outcomes and oncologic outcomes with transoral laser microsurgery.