2020/04/29 by R Mistry, Rakesh D. Mistry, Abigail Walker +4 · 18 citations
Dentistry · Medicine · #Cancer #Cancer Diagnosis and Treatment #Carcinoma #General surgery #Head and Neck Cancer Studies #Head and neck #Head and neck cancer #Internal medicine #Medicine #Neck dissection #Oral Health Pathology and Treatment #Otorhinolaryngology #Radiation therapy #Surgery #Tongue #Tonsillectomy #Transoral robotic surgery
paper · open access · doi:10.1308/rcsann.2020.0071
published in Annals of The Royal College of Surgeons of England 102(6), 442-450 (Royal College of Surgeons of England)
openalex publication_date 2020/04/29 · crossref created 2020/04/29 · crossref issued 2020/07/01 · crossref published 2020/07/01 · crossref published-print 2020/07/01 · crossref deposited 2023/05/15 · openalex created_date 2025/10/10 · crossref indexed 2026/08/04 · openalex updated_date 2026/08/05
INTRODUCTION: Head and neck carcinoma of unknown primary represents 1-5% of all head and neck cancers and presents a diagnostic and therapeutic dilemma. In approximately 40% of cases, a primary tumour location remains unknown despite investigation. With advancements in our understanding of the role of high-risk human papilloma virus in head and neck cancer, transoral robotic surgery presents an option for diagnosis and therapy. MATERIALS AND METHODS: This is a retrospective case series from a single centre. Case notes were reviewed for 28 patients who had transoral robotic surgery for head and neck carcinoma of unknown primary between May 2015 and July 2019. RESULTS: Transoral robotic surgery identified an oropharyngeal primary tumour in 19 of 28 (67.8%) patients. All oropharyngeal primaries were p16 positive. The base of tongue identification rate was 63.2%. Median length of inpatient stay postoperatively was 1.0 day. Normal oral intake resumed within 48 hours in 96% (27/28) of patients. Three patients (10.3%) suffered minor postoperative bleeds that were all managed conservatively. DISCUSSION: The base of tongue primary identification rate (63.2%) in this series is consistent with that previously reported (43-63%; 95% confidence interval). Primary tumour identification rate if a patient is p16 positive is 86.3% (19/22), with 100% of these being oropharyngeal. We suggest future investigation into p16 status as a means of stratifying patients with head and neck carcinoma of unknown primary for transoral robotic surgery. CONCLUSION: Transoral robotic base of tongue mucosectomy (or lingual tonsillectomy) is a promising technique that offers a high yield of positive identification for the primary tumour. It is well tolerated with minimal associated morbidity. Our findings are comparable with those in the current literature.