Skip to main content

Advertisement

SpringerLink
Log in

The Role of Trans Oral Robotic Surgery in the Carcinoma of Unknown Primary: A New Evidence in the Horizon?

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

The detection of the primary site in Carcinoma of Unknown Primary (CUP) is a challenging task which can significantly alter the course of management and also prognosis. Various modalities have been assessed with varying sensitivity and specificity. Imaging and cytological diagnosis have formed a key part of the diagnostic algorithm of CUP. Trans Oral Robotic Surgery offers the advantage of being both diagnostic as well as therapeutic with promising sensitivity and specificity and can form an integral part in the management of CUP. A prospective study was carried out at a tertiary care centre over a period of one year. Patients with unilateral neck swelling which was histopathologically proven squamous cell carcinoma neck metastasis were included in the study. They were evaluated with endoscopy and radiology according to the standard algorithm. When these failed to detect the primary, the patients underwent ipsilateral radical tonsillectomy and tongue base mucosal wedge biopsy via TORS. Post-operative histopathological examination was done on the resected specimens to detect the primary site. Transoral Robotic Surgery was able to localise primary in 50% of the patients enrolled in the study. Out of the primary site identified by TORS; 55.56% were located in the tonsil and 44.4% in the tongue base. TORS can offer promising detection rates of the occult primary in CUP and should form an integral part of the diagnostic algorithm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data Availability

Available on request.

References

  1. Meccariello G, Cammaroto G, Ofo E, Calpona S, Parisi E, D’Agostino G et al (2019) The emerging role of trans-oral robotic Surgery for the detection of the primary tumour site in patients with head-neck unknown primary cancers: a meta-analysis. Auris Nasus Larynx 46(5):663–671

    Article  PubMed  Google Scholar 

  2. Durmus K, Rangarajan SV, Old MO, Agrawal A, Teknos TN, Ozer E (2014) Transoral robotic approach to carcinoma of unknown primary. Head Neck 36(6):848–852

    Article  PubMed  Google Scholar 

  3. Fu TS, Foreman A, Goldstein DP, de Almeida JR (2016) The role of transoral robotic Surgery, transoral laser microsurgery, and lingual tonsillectomy in the identification of head and neck squamous cell carcinoma of unknown primary origin: a systematic review. J Otolaryngol Head Neck Surg 45(1):28

    Article  PubMed  PubMed Central  Google Scholar 

  4. Baskin RM, Boyce BJ, Amdur R, Mendenhall WM, Hitchcock K, Silver N et al (2018) Transoral robotic Surgery for oropharyngeal cancer: patient selection and special considerations. Cancer Manag Res 10:839–846

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ofo E, Spiers H, Kim D, Duvvuri U (2018) Transoral Robotic Surgery and the unknown primary. ORL J Otorhinolaryngol Relat Spec 80(3–4):148–155

    Article  PubMed  Google Scholar 

  6. Ye W, Arnaud EH, Langerman A, Mannion K, Topf MC (2021) Diagnostic approaches to carcinoma of unknown primary of the head and neck. Eur J Cancer Care 30(6):e13459

    Article  Google Scholar 

  7. Platek A, Mix M, Chowdhry V, Farrugia M, Lacombe MA, Bogart JA et al (2020) Evaluation of radiation treatment volumes for unknown primaries of the head and neck in the era of FDG PET. PLoS ONE 15(4):e0231042

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Rao KN, Gangiti KK (2021) Transoral robotic Surgery. Indian J Surg Oncol 12(4):847–853

    Article  PubMed  PubMed Central  Google Scholar 

  9. Di Maio P, Locca O, De Virgilio A, Ferreli F, Cristalli G, Pellini R et al (2019) Role of palatine tonsillectomy in the diagnostic workup of head and neck squamous cell carcinoma of unknown primary origin: a systematic review and meta-analysis. Head Neck 41(4):1112–1121

    Article  PubMed  Google Scholar 

  10. Singh P, Pathania V, Khatri M (2017) Carcinoma of unknown primary with secondary Metastasis to neck-analysis of patient and Disease related factors predicting superior patient outcomes in CUPS neck. J Evid Based Med Healthc 4:5376–5379

    Article  Google Scholar 

  11. Liu Y (2019) FDG PET/CT for metastatic squamous cell carcinoma of unknown primary of the head and neck. Oral Oncol 92:46–51

    Article  PubMed  Google Scholar 

  12. Ryan JF, Motz KM, Rooper LM, Mydlarz WK, Quon H, Gourin CG et al (2019) The impact of a Stepwise Approach to primary Tumor detection in squamous cell carcinoma of the Neck with unknown primary. Laryngoscope 129(7):1610–1616

    Article  PubMed  Google Scholar 

  13. Rinaldi V, Pagani D, Torretta S, Pignataro L (2013) Transoral robotic Surgery in the management of head and neck tumours. Ecancermedicalscience 7:359–373

    PubMed  PubMed Central  Google Scholar 

  14. Moy J, Li R (2020) Approach to the patient with unknown primary squamous cell carcinoma of the Head and Neck. Curr Treat Options Oncol 21(12):93

    Article  PubMed  Google Scholar 

  15. van Weert S, Rijken JA, Plantone F, Bloemena E, Vergeer MR, Lissenberg-Witte BI et al (2020) A systematic review on Transoral robotic Surgery (TORS) for carcinoma of unknown primary origin: has tongue base mucosectomy become indispensable? Clin Otolaryngol 45(5):732–738

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology and Head-Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Karthika Chettuvatti, Naresh Kumar Panda, Jaimanti B Bakshi, Roshan K Verma & Gyan Ranjan Nayak

  2. Department of Anaesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Nitika Goel

  3. Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Ashim Das

  4. Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Anish Bhattacharya

  5. Department of Translational and Regenerative Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Anupam Mittal

  6. Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Manish Rohilla

Authors
  1. Karthika Chettuvatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naresh Kumar Panda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jaimanti B Bakshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roshan K Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gyan Ranjan Nayak
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nitika Goel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ashim Das
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anish Bhattacharya
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Anupam Mittal
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Manish Rohilla
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KC, NKP, AD and AM collected the data. KC, NKP, JBB, GRN, and RV prepared the manuscript. KC, NKP, NG, MR, GRN, and AB revised the manuscript. KC, NKP, JBB, and GRN did the final editing and submission. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Naresh Kumar Panda.

Ethics declarations

Ethical Approval and Consent to Participate

Taken.

Ethical Committee Name

Institutional Ethical Committee, Post Graduate Institute of Medical Education and Research Chandigarh.

Ethical Committee Reference Number

NK/5912/MS/160.

Consent for publication

Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. A copy of the consent form is available for review by the Editor of this journal.

Competing Interests

None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chettuvatti, K., Panda, N.K., Bakshi, J.B. et al. The Role of Trans Oral Robotic Surgery in the Carcinoma of Unknown Primary: A New Evidence in the Horizon?. Indian J Otolaryngol Head Neck Surg 76, 1941–1948 (2024). https://doi.org/10.1007/s12070-023-04460-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-023-04460-3

Keywords

Search

Navigation