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

Faisal Alzahrani; Axel Sahovaler; Neil Mundi; Almoaidbellah Rammal; Naif Fnais; S Danielle MacNeil; Adrian Mendez; John Yoo; Kevin Fung; Francisco Laxague; Andrew Warner; David A Palma; Anthony Nichols

doi:10.1002/hed.27023

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

Head Neck. 2022 May;44(5):1206-1212. doi: 10.1002/hed.27023. Epub 2022 Feb 27.

Authors

Faisal Alzahrani^{1

2}, Axel Sahovaler¹, Neil Mundi³, Almoaidbellah Rammal⁴, Naif Fnais^{1

2}, S Danielle MacNeil¹, Adrian Mendez¹, John Yoo¹, Kevin Fung¹, Francisco Laxague¹, Andrew Warner⁵, David A Palma⁵, Anthony Nichols¹

Affiliations

¹ Department Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.
² Department Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia.
³ Department of Otolaryngology, Southern Illinois University, Springfield, Illinois, USA.
⁴ Department Otolaryngology-Head and Neck Surgery, King AbdulAziz University, Jeddah, Saudi Arabia.
⁵ Department of Radiation Oncology, Western University, London, Ontario, Canada.

PMID: 35224796
DOI: 10.1002/hed.27023

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.

Keywords: carcinoma of unknown primary; complications; transoral robotic surgery; treatment delay; weight.

MeSH terms

Head and Neck Neoplasms* / surgery
Humans
Neoplasms, Unknown Primary* / pathology
Robotic Surgical Procedures* / methods
Squamous Cell Carcinoma of Head and Neck / surgery
Tonsillectomy* / methods