Transoral Robotic Approach to Carcinoma of Unknown Primary

Overview

Journal Head Neck

Specialties General Surgery
Oncology

Date 2013 May 31

PMID 23720223

Citations 27

Authors

Kasim Durmus

Sanjeet V Rangarajan

Matthew O Old

Amit Agrawal

Theodoros N Teknos

Enver Ozer

Affiliations

Soon will be listed here.

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.

Citing Articles

Surgical Puzzle: Concurrent Comprehensive Neck Dissection Strategies Unravelling the Mystery of Carcinoma Unknown Primary when Performed with TORS Radical Tonsillectomy and Mucosal Tongue Base Wedge Biopsy in Northern Indian Cohort.

Panda N, Chettuvatti K, Bakshi J Indian J Otolaryngol Head Neck Surg. 2024; 76(6):5201-5208.

PMID: 39559050 PMC: 11569348. DOI: 10.1007/s12070-024-04945-9.

The emerging role of robotics in plastic and reconstructive surgery: a systematic review and meta-analysis.

Awad L, Reed B, Bollen E, Langridge B, Jasionowska S, Butler P J Robot Surg. 2024; 18(1):254.

PMID: 38878229 PMC: 11180031. DOI: 10.1007/s11701-024-01987-7.

The Role of Trans Oral Robotic Surgery in the Carcinoma of Unknown Primary: A New Evidence in the Horizon?.

Chettuvatti K, Panda N, Bakshi J, Verma R, Nayak G, Goel N Indian J Otolaryngol Head Neck Surg. 2024; 76(2):1941-1948.

PMID: 38566719 PMC: 10982237. DOI: 10.1007/s12070-023-04460-3.

Transoral Laser Resection of the Tongue Base in the Workup of Unknown Primary Head and Neck Squamous Cell Carcinoma.

Chan S, McLarty J, Knecht E, Lee S Cureus. 2023; 15(6):e41103.

PMID: 37519526 PMC: 10382210. DOI: 10.7759/cureus.41103.

Early Improved Functional Outcomes in Head and Neck Cancer Patients with Primary Tumor Detection.

Kalavacherla S, Bernard B, Kim S, Dornisch A, Blumenfeld L, Linnemeyer-Risser K Laryngoscope. 2023; 134(2):701-707.

PMID: 37462352 PMC: 10874284. DOI: 10.1002/lary.30903.

References

Karni R, Rich J, Sinha P, Haughey B . Transoral laser microsurgery: a new approach for unknown primaries of the head and neck. Laryngoscope. 2011; 121(6):1194-201. DOI: 10.1002/lary.21743. View

Rudmik L, Lau H, Wayne Matthews T, Bosch J, Kloiber R, Molnar C . Clinical utility of PET/CT in the evaluation of head and neck squamous cell carcinoma with an unknown primary: a prospective clinical trial. Head Neck. 2011; 33(7):935-40. DOI: 10.1002/hed.21566. View

Mehta V, Johnson P, Tassler A, Kim S, Ferris R, Nance M . A new paradigm for the diagnosis and management of unknown primary tumors of the head and neck: a role for transoral robotic surgery. Laryngoscope. 2012; 123(1):146-51. DOI: 10.1002/lary.23562. View

Keller F, Psychogios G, Linke R, Lell M, Kuwert T, Iro H . Carcinoma of unknown primary in the head and neck: comparison between positron emission tomography (PET) and PET/CT. Head Neck. 2011; 33(11):1569-75. DOI: 10.1002/hed.21635. View

Chen Y, Yang X, Li S, Wang Y, He J, Yang Y . Value of fused positron emission tomography CT in detecting primaries in patients with primary unknown cervical lymph node metastasis. J Med Imaging Radiat Oncol. 2012; 56(1):66-74. DOI: 10.1111/j.1754-9485.2011.02331.x. View

Compton A, Moore-Medlin T, Herman-Ferdinandez L, Clark C, Caldito G, Wang X . Human papillomavirus in metastatic lymph nodes from unknown primary head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg. 2011; 145(1):51-7. DOI: 10.1177/0194599811400385. View

Balaker A, Abemayor E, Elashoff D, St John M . Cancer of unknown primary: does treatment modality make a difference?. Laryngoscope. 2012; 122(6):1279-82. DOI: 10.1002/lary.22424. View

Pattani K, Goodier M, Lilien D, Kupferman T, Caldito G, Nathan C . Utility of panendoscopy for the detection of unknown primary head and neck cancer in patients with a negative PET/CT scan. Ear Nose Throat J. 2011; 90(8):E16-20. DOI: 10.1177/014556131109000818. View

Roeser M, Alon E, Olsen K, Moore E, Manduch M, Wismayer D . Synchronous bilateral tonsil squamous cell carcinoma. Laryngoscope. 2011; 120 Suppl 4:S181. DOI: 10.1002/lary.21645. View

10.

Strojan P, Ferlito A, Langendijk J, Corry J, Woolgar J, Rinaldo A . Contemporary management of lymph node metastases from an unknown primary to the neck: II. a review of therapeutic options. Head Neck. 2011; 35(2):286-93. DOI: 10.1002/hed.21899. View

11.

Waltonen J, Ozer E, Hall N, Schuller D, Agrawal A . Metastatic carcinoma of the neck of unknown primary origin: evolution and efficacy of the modern workup. Arch Otolaryngol Head Neck Surg. 2009; 135(10):1024-9. DOI: 10.1001/archoto.2009.145. View

12.

Funk G . A head and neck surgeon's perspective on best practices for the use of PET/CT scans for the diagnosis and treatment of head and neck cancers. Arch Otolaryngol Head Neck Surg. 2012; 138(8):748-52. DOI: 10.1001/archoto.2012.1404. View

13.

Abuzeid W, Bradford C, Divi V . Transoral robotic biopsy of the tongue base: A novel paradigm in the evaluation of unknown primary tumors of the head and neck. Head Neck. 2011; 35(4):E126-30. DOI: 10.1002/hed.21968. View

14.

Cerezo L, Raboso E, Ballesteros A . Unknown primary cancer of the head and neck: a multidisciplinary approach. Clin Transl Oncol. 2011; 13(2):88-97. DOI: 10.1007/s12094-011-0624-y. View

15.

Zollinger L, Wiggins R . A head and neck radiologist's perspective on best practices for the usage of PET/CT scans for the diagnosis and treatment of head and neck cancers. Arch Otolaryngol Head Neck Surg. 2012; 138(8):754-8. DOI: 10.1001/archoto.2012.1408. View

16.

Zengel P, Assmann G, Mollenhauer M, Jung A, Sotlar K, Kirchner T . Cancer of unknown primary originating from oropharyngeal carcinomas are strongly correlated to HPV positivity. Virchows Arch. 2012; 461(3):283-90. DOI: 10.1007/s00428-012-1290-3. View

17.

Strojan P, Ferlito A, Medina J, Woolgar J, Rinaldo A, Robbins K . Contemporary management of lymph node metastases from an unknown primary to the neck: I. A review of diagnostic approaches. Head Neck. 2011; 35(1):123-32. DOI: 10.1002/hed.21898. View

18.

Perkins S, Spencer C, Chernock R, Haughey B, Nussenbaum B, Adkins D . Radiotherapeutic management of cervical lymph node metastases from an unknown primary site. Arch Otolaryngol Head Neck Surg. 2012; 138(7):656-61. DOI: 10.1001/archoto.2012.1110. View

19.

Han A, Xue J, Hu M, Zheng J, Wang X . Clinical value of 18F-FDG PET-CT in detecting primary tumor for patients with carcinoma of unknown primary. Cancer Epidemiol. 2012; 36(5):470-5. DOI: 10.1016/j.canep.2012.03.002. View

20.

Ozer E, Naiboglu B, Meacham R, Ryoo C, Agrawal A, Schuller D . The value of PET/CT to assess clinically negative necks. Eur Arch Otorhinolaryngol. 2012; 269(11):2411-4. DOI: 10.1007/s00405-012-1926-6. View