Background: Head and neck cancer patients often experience muscle wasting due to malnutrition and the hypermetabolism of cancer. For those undergoing total laryngectomy, there is the potential for peri-operative complications. Sarcopenia has gained recognition as a prognostic factor in head and neck cancer. However, there is marked variability in the ways sarcopenia is defined and poor characterisation of its effect in patients undergoing total laryngectomy. This review evaluates the role of computed tomography-confirmed sarcopenia on postoperative outcomes for patients subjected to total laryngectomy. Methods: A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Four studies encompassing 475 patients were included. There was evidence that sarcopenia as defined by computed tomography is a prognostic indicator of total postoperative complications (OR 2.29, 95% CI 1.05 – 4.97, p=0.04) and pharyngocutaneous fistula development (OR 2.28, 95% CI 1.45 – 3.59, p=0.0004) following total laryngectomy for cancer. This is based on a foundation of studies at moderate risk of bias. Conclusion: Computed tomography-proven sarcopenia is a significant prognostic marker for postoperative complications and pharyngocutaneous fistula formation in cancer patients undergoing total laryngectomy. This finding is based on single-institution observational evidence with high clinical heterogeneity and poor control for confounders. Larger prospective clinical trials are required to further characterise the impact of sarcopenia on outcomes following total laryngectomy.