Transoral robotic approach to carcinoma of unknown primary

Abstract

Background The management of carcinoma of unknown primary (CUP) is one of the challenging conditions in head and neck oncologic surgery. Despite various diagnostic tools, the primary tumor site in more than half of cases remains unidentified. The purpose of this study was to assess the feasibility and efficiency of utilizing transoral robotic surgery (TORS) for the diagnosis and treatment of CUP in the head and neck. Methods In this prospective, single-institutional, clinical TORS trial, 22 of 181 patients were treated for CUP between 2008 and 2012. Results Among all those 22 patients, primary tumor site identification and complete tumor removal was achieved in 17 patients (77.3%) with TORS. Tonsil (59.1%) and base of tongue (18.1%) were identified as the most common tumor locations. Conclusion Together with panendoscopy, directed biopsies, and positron emission tomography (PET)/CT, TORS is a valuable option in the identification and treatment of primary tumor sites.

Approach to Metastatic Carcinoma of Unknown Primary in the Head and Neck: Squamous Cell Carcinoma and Beyond

“…If a primary tumor is not found by this initial approach, for patients with level II or III lymph node metastases, ipsilateral tonsillectomy and base of tongue resection, by either transoral robotic surgery (TORS) or transoral laser surgery (TLM), is associated with a much higher rate of primary tumor detection and is now standard at many institutions. Reported primary tumor detection rates are up to 94 % for TLM (compared to 25 % for a traditional panendoscopic approach) and 77.3 % for TORS [26,27]. Some advocate bilateral tonsillectomy, since occult primary SCC may be found in the contralateral tonsil in a minority of cases.…”

Impact of the 8th edition of the UICC TNM classification on staging and survival in patients with neck metastases of unknown primary tumor

“…Recent case series have reported high rates of detection ranging from 86 to 94% including TLM [38,39] and 72 to 90% including TORS [37,38,40] in the diagnostic work-up of patients with suspected CUP. According to Durmus et al [41] the PT was identified in 77% of patients (17 of 22) with 80% HPV-positive LNM residing in the palatine tonsil in 59% (13 of 22), and the BOT in 18% (4 of 22). In a study by Channir et al [42] the PT was identified by TORS in 7/13 patients (54%) at the lingual tonsils with HPV-positive LNM in all of these patients.…”

Current Approaches to Primary Unknown Neck Metastases

“…Literatür bilgisi ışığında PBM' da primer lezyonu bulmak için transervikal USG ile hipoekoik lezyon aranmasının yararlı olabileceği söylenebilir (18). Literatürde PET-BT'de primer lezyon gösterilememiş ve transoral robotik cerrahi (TORS) ile lingual tonsillektomi yapılarak dil kökünde primer odağın saptandığı yayınlar mevcuttur (19)(20)(21). TORS ile lingual tonsillektomi PBM'da yeni bir uygulamadır ve primer lezyonu saptamada faydalı olarak görülmektedir (19)(20)(21).…”

“…Literatürde PET-BT'de primer lezyon gösterilememiş ve transoral robotik cerrahi (TORS) ile lingual tonsillektomi yapılarak dil kökünde primer odağın saptandığı yayınlar mevcuttur (19)(20)(21). TORS ile lingual tonsillektomi PBM'da yeni bir uygulamadır ve primer lezyonu saptamada faydalı olarak görülmektedir (19)(20)(21). Primer lezyonu saptamak için immünohistokimyasal ve moleküler çalışmalar yapılabilir.…”