Saadia Farooq1, Sunil Khandavilli1, Janine Dretzke2, David Moore2, Paul C Nankivell3, Neil Sharma3, John R de Almeida4, Stuart C Winter5, Christian Simon6, Vinidh Paleri7, Mrganke De8, Somiah Siddiq8, Christopher Holsinger9, Robert L Ferris10, Hisham Mehanna11. 1. Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 2. Institute of Head and Neck Studies and Education, University of Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, UK. 3. Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Head and Neck Studies and Education, University of Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, UK. 4. Department of Otolaryngology- Head and Neck Surgery, Princess Margaret Cancer Center/University Health Network, Toronto, Canada. 5. Nuffield Department of Surgical Sciences, University of Oxford. Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, UK. 6. Department of Otolaryngology - Head and Neck Surgery, CHUV, UNIL, Lausanne, Switzerland. 7. Department of Otolaryngology, Head and Neck Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, UK. 8. Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Head and Neck Studies and Education, University of Birmingham, UK. 9. Department of Otolaryngology, Head and Neck Surgery, Stanford University Medical Center, U.S.A. 10. Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania, U.S.A. 11. Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Head and Neck Studies and Education, University of Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, UK. Electronic address: h.mehanna@bham.ac.uk.
Abstract
BACKGROUND: The use of transoral robotic surgery (TORS) and laser microsurgery (TLM) in the diagnosis and identification of the site of the unknown primary has become increasingly common. This systematic review and meta-analysis aims to assess the use and efficacy of TORS and TLM for this indication. METHOD: Systematic review and meta-analysis of studies employing TORS or TLM in diagnosis of the unknown primary tumor site in patients with cervical nodal metastases of squamous cell origin. MEDLINE, EMBASE and CINHAL were searched from inception to July 2018 for all studies that used TORS and or TLM in identifying the unknown primary. RESULTS: 251 studies were identified, of which 21 were eligible for inclusion. The primary tumour was identified by TORS/TLM in 78% of patients (433 out of 556). Tongue base mucosectomy (TBM) identified the primary in 222 of 427 cases (53%). In patients with negative physical examination, diagnostic imaging and PETCT, TBM identified the primary in 64% (95% CI 50, 79) cases. In patients who had negative CT/MRI imaging, negative PETCT and negative EUA and tonsillectomy, TBM identified a tongue base primary in 78% (95% CI 41, 92) cases. Haemorrhage, the commonest complication, was reported in 4.9% cases. Mean length of stay varied between 1.4 and 6.3 days. CONCLUSION: Tongue base mucosectomy, performed by TORS or TLM, is highly efficacious in identifying the unknown primary in the head and neck region.
BACKGROUND: The use of transoral robotic surgery (TORS) and laser microsurgery (TLM) in the diagnosis and identification of the site of the unknown primary has become increasingly common. This systematic review and meta-analysis aims to assess the use and efficacy of TORS and TLM for this indication. METHOD: Systematic review and meta-analysis of studies employing TORS or TLM in diagnosis of the unknown primary tumor site in patients with cervical nodal metastases of squamous cell origin. MEDLINE, EMBASE and CINHAL were searched from inception to July 2018 for all studies that used TORS and or TLM in identifying the unknown primary. RESULTS: 251 studies were identified, of which 21 were eligible for inclusion. The primary tumour was identified by TORS/TLM in 78% of patients (433 out of 556). Tongue base mucosectomy (TBM) identified the primary in 222 of 427 cases (53%). In patients with negative physical examination, diagnostic imaging and PETCT, TBM identified the primary in 64% (95% CI 50, 79) cases. In patients who had negative CT/MRI imaging, negative PETCT and negative EUA and tonsillectomy, TBM identified a tongue base primary in 78% (95% CI 41, 92) cases. Haemorrhage, the commonest complication, was reported in 4.9% cases. Mean length of stay varied between 1.4 and 6.3 days. CONCLUSION: Tongue base mucosectomy, performed by TORS or TLM, is highly efficacious in identifying the unknown primary in the head and neck region.
Keywords:
Cancer of unknown origin; Head and neck cancer; Microsurgery; Tongue base mucosectomy; Trans oral LASER; Trans oral robotic surgery; Unknown primary
Authors: Christoph Winkler; Andreas Strobl; Thomas J Schmal; Maximilian Hartl; Martin Burian; Michael Formanek Journal: Wien Med Wochenschr Date: 2021-08-02
Authors: Mihir R Patel; Lauren Ottenstein; Martha Ryan; Annie Farrell; Matthew Studer; H Michael Baddour; Kelly Magliocca; Christopher Griffith; William Stokes; Jeffrey Switchenko; Ashley Aiken; Mark El-Deiry; C Arturo Solares; Conor Steuer; Nabil Saba; Jonathan Beitler Journal: Oral Oncol Date: 2021-04-17 Impact factor: 5.337
Authors: Stijn van Weert; Johannes A Rijken; Francesca Plantone; Elisabeth Bloemena; Marije R Vergeer; Birgit I Lissenberg-Witte; C René Leemans Journal: Clin Otolaryngol Date: 2020-05-25 Impact factor: 2.597
Authors: Diako Berzenji; Dominiek A Monserez; Gerda M Verduijn; Emilie A C Dronkers; Peter P Jansen; Stijn Keereweer; Aniel Sewnaik; Robert J Baatenburg de Jong; Jose A Hardillo Journal: Laryngoscope Investig Otolaryngol Date: 2021-03-26