Transoral robotic surgery for the identification of unknown primary head and neck squamous cell carcinomas: Its effect on the wait and the weight

Abstract

Background Neck carcinoma of unknown primary (CUP) is a frequent scenario. Transoral robotic mucosectomies (TORM) of pharynx have increased rate of primary identification, but come with cost of treatment delay. Methods We reviewed patients who underwent CUP protocol from 2014 to 2020. Patients with cervical nodes carcinoma and failure to localize a primary source were classified as CUP. We determined primary identification rate and postoperative complications. Results We included 65 patients underwent TORM. Surgical approach consisted of lingual and/or palatine tonsillectomies. The primary detection rate was 49.2%. Average weight reduction was 2.5 ± 4.3 kg. The average number of days from consultation to definitive treatment was 52.2 ± 18.3. Conclusion A systematic approach to patients with CUP showed a promising primary identification rate compared to panendoscopy alone. TORM carries a small risk of complications. The benefits of primary identification must be weighed with the morbidity and delay to definitive treatment.

Perception of Young European Otolaryngologists toward Transoral Robotic Surgery in Head and Neck Oncology and Surgery

“…In our survey, both non-TORS and TORS head and neck surgeons reported similar overall indication outcomes. Precisely, most head and neck surgeon participants considered sleep apnea-related base of tongue surgery and cT1-T2 oropharyngeal and supraglottic cancers as the most appropriate indications of TORS, which match with the most accepted indications in the literature [ 6 , 16 , 17 , 18 , 19 ]. However, notably, European non-TORS and TORS head and neck surgeons appear to be less familiar with fewer common indications, e.g., Sistrunk procedure, laryngocele excision, nasopharyngeal cancer, or thyroid surgery [ 20 , 21 , 22 ].…”

Adoption of otolaryngologist‐head neck surgeons toward transoral robotic surgery: An international survey

“…An adequate training improves TORS indications, skills surgical and oncological outcomes, which are important points to increase the surgeon satisfaction and motivation in the use of a new procedure. According to the literature, the most accepted indications of TORS remain cT1‐T2 and selected cT3 oropharyngeal and supraglottic cancers, 3 , 5 , 18 tongue‐base surgery (sleep apnea and unknown primary head and neck cancer), 19 , 20 and, particularly in Asia, thyroid surgeries. 21 In the present survey, we observed that the theoretical TORS indications reported by TORS surgeons were closer to the literature indications compared to non‐TORS surgeons.…”

The role of transoral surgery in the diagnosis of the carcinoma of unknown origin of the head and neck

“…The reported mean length of stay varied between 1.4 and 6.3 days [27]. It should be noted that TORS TBM results in significantly less acute morbidity than therapeutic base of tongue TORS, with OR of 0.39 (P ¼ 0.081) of moderate/severe dysphagia as determined by DIGEST overall scores for TBM compared with resection for a primary [28].…”