A new paradigm for the diagnosis and management of unknown primary tumors of the head and neck: A role for transoral robotic surgery

  title={A new paradigm for the diagnosis and management of unknown primary tumors of the head and neck: A role for transoral robotic surgery},
  author={Vikas Mehta and Paul Johnson and Andrew B. Tassler and Seungwon Kim and Robert L Ferris and Melonie Nance and Jonas T. Johnson and U. Duvvuri},
  journal={The Laryngoscope},
In 2% to 3% of patients with cancer metastatic to cervical lymph nodes, a primary tumor will not be found despite exhaustive diagnostic efforts. The treatment for these patients includes cervical lymphadenectomy followed by radiation to areas with increased risk of harboring a mucosal primary. Wide‐field radiation therapy increases the incidence of xerostomia and dysphagia. Localizing a primary tumor has thus both therapeutic and quality‐of‐life implications, allowing possible complete surgical… 

Transoral robotic surgery for carcinoma of unknown primary in the head and neck

The authors' treatment paradigm is presented and the literature supporting the use of TORS in the management of CUP is reviewed, highlighting its importance in optimizing identification and resection of the primary tumor.

Role of Transoral Robotic Surgery in the Work-up of the Unknown Primary.

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Transoral robotic surgery (TORS) has proven to be an effective technique to safely treat oropharyngeal and select supraglottic tumors surgically and the literature supports its safety and efficacy based on numerous studies.

Transoral Robotic Surgery and the Unknown Primary

The indication, surgical technique, evidence base, and controversies of performing TORS in the context of the unknown primary are presented.

When is surgical therapy for head and neck malignant epithelial tumors not indicated?

The reasons for recommending non-surgical therapies for certain epithelial cancers of the head and neck are examined, weighed against the best quality of life and functional outcomes after treatment.

Transoral Robotic Surgery–Assisted Endoscopy With Primary Site Detection and Treatment in Occult Mucosal Primaries

The efficacy of a TORS-assisted approach to identify and surgically treat the primary tumor in patients presenting with CUP is demonstrated and results in deintensification of treatment by eliminating the need for chemotherapy in the majority of patients, as well as avoiding radiation therapy in select patients.

Transoral robotic surgery base of tongue mucosectomy for head and neck cancer of unknown primary

Head and neck cancer of unknown primary (HNCUP) is a source of diagnostic uncertainty. Patients presenting with cytologically positive neck lumps without a clinically identifiable primary, require

Finding/identifying primaries with neck disease (FIND) clinical trial protocol: a study integrating transoral robotic surgery, histopathological localisation and tailored deintensification of radiotherapy for unknown primary and small oropharyngeal head and neck squamous cell carcinoma

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Transoral robotic surgery (TORS) is a minimally invasive surgical approach that offers surgical access to the oropharynx without the morbidity of open procedures while achieving excellent oncologic and functional outcomes.



Metastatic carcinoma of the neck of unknown primary origin: evolution and efficacy of the modern workup.

Diagnostic workup including PET-CT, alongside panendoscopy with directed biopsies including bilateral tonsillectomy, offers the greatest likelihood of successfully identifying occult primary tumor location.

Results of salvage treatment of the neck in patients with oral cancer.

  • L. Kowalski
  • Medicine
    Archives of otolaryngology--head & neck surgery
  • 2002
Patients undergoing previous neck dissection and with recurrences diagnosed after 6 months are not usually candidates for curative salvage treatment and are at a high risk for death.

Diagnostic strategies in cervical carcinoma of an unknown primary (CUP)

The prognosis of patients with cervical carcinoma metastases of the upper- and midneck is much more favorable than that of customers with a CUP syndrome of other localizations, and blind but systematic pharyngeal biopsies, including bilateral tonsillectomy, should be performed.

Oncologic Rationale for Bilateral Tonsillectomy in Head and Neck Squamous Cell Carcinoma of Unknown Primary Source

The rate of contralateral spread of metastatic cancer from occult tonsil lesions appears to approach 10%.

Transoral robotic biopsy of the tongue base: A novel paradigm in the evaluation of unknown primary tumors of the head and neck

Diagnosis of squamous cell carcinoma of the head and neck can present as a cervical metastasis from an unknown primary site but this will fail to identify a portion of unknown primary tumors.

Cervical lymph node metastasis from an unknown primary: is a tonsillectomy necessary?

Intensity-modulated radiotherapy for cervical lymph node metastases from unknown primary cancer.