Transoral Robotic Surgery and the Unknown Primary

Introduction Carcinoma of unknown primary site (CUP) refers to 1–5% of all head and neck neoplasms. Very often, the primary site remains difficult to determine. Squamous cell carcinoma is the most frequent histopathological type diagnosed in the head and neck region. According to statistics, a primary site is usually located in the oropharynx. Study objective The study presents diagnostic difficulties and the methods of diagnosing and the therapy of CUP and primary sites in patients treated in the region of Lower Silesia and Silesia. The aim of the study was to show a retrospective analysis of 233 CUP patients to assess how clinical features, diagnosis and treatment affect the survival of patients. Material and methods The diagnostics of patients included panendoscopy with specimen collection (nasoendoscopy, laryngoscopy, esophagoscopy, brochoscopy), computed tomography examination of the neck, chest, abdomen and pelvis minor, as well as positron emission tomography examination. Tonsilletomy was performed in 37 patients. Neck dissection was carried out in 109 subjects and 165 patients were treated bt radiotherapy, and 135 by chemotherapy. Conclusions Tonsillectomy is required in CUP patients with the negative results of biopsy and imaging tests. It gives a possibility of detecting the primary site and improves the results of treatment and survival of CUP patients.Combination therapy, including surgical treatment and chemoradiotherapy, gives the best therapeutic results in CUP patients. The general condition of patient and younger age have an impact on prognosis and survival.

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“…According to Enyinnaya et al, N1 type was found in 1%, N2 in 69.5% and N3 in 32% 24. Similar results were obtained in our study.…”

Section: Discussionsupporting

confidence: 92%

<p>The impact of the patient’s condition, diagnostic procedures and treatment on the survival of carcinoma of unknown primary site patients</p>

Dorobisz

Włodarska−Polińska²,

Pazdro-Zastawny

et al. 2019

CMAR

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“…Patients with unknown primary neck metastasis commonly go through an array of examinations, such as flexible endoscopic assessment, palpation of the tonsils and base of the tongue, and PET-CT. If the primary tumor remains elusive, TORS palatine and lingual tonsillectomy can be employed as part of the staging algorithm (42). The lymphoepithelial tissue of the tongue base from the circumvallate papillae to vallecula can be removed by TORS (26).…”

Section: Extended Applications Of Torsmentioning

confidence: 99%

The dawn of robotic surgery in otolaryngology-head and neck surgery

Nakayama

Holsinger

Chevalier

et al. 2019

Japanese Journal of Clinical Oncology

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Transoral robotic surgery (TORS) utilizing the da Vinci robotic system has opened a new era for minimally-invasive surgery (MIS) in Otolaryngology-Head and Neck Surgery. Awareness of the historical steps in developing robotic surgery (RS) and understanding its current application within our field can help open our imaginations to future of the surgical robotics. We compiled a historical perspective on the evolution of surgical robotics, the road to the da Vinci surgical system, and conducted a review of TORS regarding clinical applications and limitations, prospective clinical trials and current status in Japan. We also provided commentary on the future of surgical robotics within our field. Surgical robotics grew out of the pursuit of telerobotics and the advances in robotics for non-medical applications. Today in our field, cancers and diseases of oropharynx and supraglottis are the most common indications for RS. It has proved capable of preserving the laryngopharyngeal function without compromising oncologic outcomes, and reducing the intensity of adjuvant therapy. TORS has become a standard modality for MIS, and will continue to evolve in the future. As robotic surgical systems evolve with improved capabilities in visual augmentation, spatial navigation, miniaturization, force-feedback and cost-effectiveness, we will see further advances in the current indications, and an expansion of indications. By promoting borderless international collaborations that put 'patients first', the bright future of surgical robotics will synergistically expand to the limits of our imaginations.

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“…2,9 However, literature suggests PET-CT provides additional primary tumour detection rates in HNCUP over conventional imaging techniques in 37-44% of cases with a sensitivity and specificity of 97% and 68%, respectively. 10 Specifically, data suggest identification of sub-centimetre lesions is of particular difficulty (and in this case the lesion being 9 mm). Consequently, TORS provides a useful adjunct for Head and Neck surgeons and patients in identifying a primary lesion that is smaller than the resolution offered by PET CT, which can often be the case with HPV-positive patients who experience early metastasise with bulky lymph nodes.…”

Section: Discussionmentioning

confidence: 92%

Royal Society of Medicine Surgical Innovation Day Adrian Tanner Prize Winner 2019: Multidisciplinary care and surgical innovation for the benefit of the patient with head and neck cancer of unknown primary

Mistry

Walker

et al. 2020

JRSM Open

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Head and neck carcinoma of unknown primary accounts for approximately 1–5% of all head and neck cancers and presents a genuine diagnostic and therapeutic dilemma. Despite advanced investigations, the primary tumour location remains unknown in up to 40% of these cases. Transoral robotic surgery presents a viable diagnostic and therapeutic option in these patients. This surgical innovation alongside advances in the understanding of head and neck cancer biology means that a multidisciplinary approach in the management of these complex patients is of utmost importance to ensure optimal therapeutic outcomes.

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Transoral Robotic Surgery and the Unknown Primary

Cited by 23 publications

References 33 publications

<p>The impact of the patient’s condition, diagnostic procedures and treatment on the survival of carcinoma of unknown primary site patients</p>

<p>The impact of the patient’s condition, diagnostic procedures and treatment on the survival of carcinoma of unknown primary site patients</p>

The dawn of robotic surgery in otolaryngology-head and neck surgery

Royal Society of Medicine Surgical Innovation Day Adrian Tanner Prize Winner 2019: Multidisciplinary care and surgical innovation for the benefit of the patient with head and neck cancer of unknown primary

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