Robotic Surgery for Primary Head and Neck Squamous Cell Carcinoma of Unknown Site

Patel, Seraphim; Magnuson, J. Scott; Holsinger, F. Christopher; Karni, Ron J.; Richmon, Jeremy D.; Gross, Neil D.; Bhrany, Amit D.; Ferrell, Jay K.; Ford, Samuel E.; Kennedy, Aimee A.; Méndez, Eduardo

doi:10.1001/jamaoto.2013.5189

Cited by 91 publications

(89 citation statements)

References 39 publications

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“…Some recent studies suggest that transoral laser microsurgery (TLM) or transoral robotic surgery (TORS) is more effective for the identification of a primary in the oropharynx especially in the base of tongue (BOT) in patients with suspected CUP [37,38]. 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.…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

Section: Discussionmentioning

confidence: 99%

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

Nussbaumer-Vorburger¹,

Förbs²,

Jochum³

et al. 2017

Otorhinolaryngol Head Neck Sur

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Objectives: The aims of this study were to assess the predictive value of HPV-positivity in cervical lymph node metastases for the detection of a primary tumor (PT), to investigate the influence of HPV-positivity in cervical lymph node metastases on tumor control and survival and to analyse the impact of the 8 th edition of the UICC TNM classification on staging and survival.Methods: Neck dissection specimen of 47 consecutively included patients were analysed by PCR-based HPV DNA-testing and p16-immunostaining and survival analysis by Kaplan-Meier and Cox proportional hazard regression models were performed. Results:After standard work-up algorithm in patients with suspected CUP 27/47 patients (57%) remained a CUP whereas in 20/47 (43%) a PT was detected (tonsils, lung, parotid gland, skin). 14/20 (70%) with detected PT and 9/27 (30%) with CUP had HPV-positive cervical lymph node metastases (LNM). Sensitivity, specificity, positive predictive value and negative predictive value of HPV-positivity in LNM for diagnosis of a PT in the oropharynx achieved 65%, 95%, 94% and 69%, respectively. In the subgroup of patients with CUP the 5-year overall/disease specific survival (OS/DSS) of patients with HPV-positive compared to HPVnegative LNM was higher (5y-OS 73% vs. 41%, p=0.01, 5y-DSS 73% vs. 53%, p=0.02). The use of the new UICC TNM classification leads to down staging of 65% of patients with detected PT and 33% with CUP. Furthermore, advanced N-category becomes an important negative prognosticator for OS (N≥2: HR 3.05, 95% CI 1.21-7.67, p=0.01). Conclusion:HPV-positivity in LNM directs the detection of PT in the oropharynx in patients with CUP. One third of LNM in patients with CUP were HPVpositive associated with improved OS and DSS. When applying the 8 th edition advanced N-category and UICC stages are negative prognosticators for survival supporting the role for integration of biomarkes in staging systems.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Nussbaumer-Vorburger¹,

Förbs²,

Jochum³

et al. 2017

Otorhinolaryngol Head Neck Sur

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“…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).…”

Section: Lap Lokalizasyonu Ile Primer Lezyonun İlişkisiunclassified

“…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.…”

Section: Lap Lokalizasyonu Ile Primer Lezyonun İlişkisiunclassified

Current Approaches to Primary Unknown Neck Metastases

Başal¹,

Eryılmaz²

2016

Van Med J

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“…TORS is currently being used in the management of early-stage tumors, more advanced malignancies, tumor recurrences, deep neck space infections, tumors of unknown primary site, and comparatively benign conditions such as obstructive sleep apnea [1,[15][16][17][18]. The incidence of postoperative complications seen with TORS is generally low and has the potential to be further reduced by increased experience with the technique and an appreciation of risk factors for the most common issues [5,[19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx

et al. 2017

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Background: Transoral endoscopic head and neck surgery (eHNS), including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), provides access to subsites in the head and neck that have traditionally been difficult to approach. Minor salivary gland tumors, while relatively uncommon, are frequently malignant and can occur at sites in the oropharynx accessible by transoral eHNS. Presented here is the largest review to date of patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS as primary or salvage therapy. Methods: A retrospective chart review was performed, including data from 20 patients with minor salivary gland tumors of the oropharynx managed with transoral eHNS at 2 tertiary, academic medical centers. Details of tumor pathology, margin analysis, adjuvant therapy, and an assessment of oncologic outcome were included. Results: The base of tongue was the most common tumor site (75%). Adenoid cystic carcinoma (ACC) accounted for most cases (35%), and negative margins were obtained in most (95%) through an endoscopic-only approach. Overall, 50% of patients received post-operative radiation therapy. Postoperative complications were limited, with one patient (5%) returning to the OR for control of post-operative oropharyngeal bleeding. On average follow-up of 36 months, 90% of patients were alive with no evidence of recurrence.

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Robotic Surgery for Primary Head and Neck Squamous Cell Carcinoma of Unknown Site

Abstract: We demonstrate that TORS is a useful approach to identify and treat the primary site in patients with HNSCC who present with an unknown primary site.

Cited by 91 publications

References 39 publications

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

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

Current Approaches to Primary Unknown Neck Metastases

Transoral endoscopic head and neck surgery (eHNS) for minor salivary gland tumors of the oropharynx

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