Mistry R, Walker A, Kim D, Ofo E
St George's University Hospitals NHS Foundation Trust, Tooting, London, UK.
Ann R Coll Surg Engl. 2020 Jul;102(6):442-450. doi: 10.1308/rcsann.2020.0071. Epub 2020 Apr 29.
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.
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.
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.
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.
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.
原发灶不明的头颈癌占所有头颈癌的1%-5%，带来了诊断和治疗上的难题。在约40%的病例中，尽管进行了检查，原发肿瘤的位置仍不清楚。随着我们对高危人乳头瘤病毒在头颈癌中作用的认识不断进步，经口机器人手术为诊断和治疗提供了一种选择。
这是来自单一中心的回顾性病例系列研究。对2015年5月至2019年7月期间因原发灶不明的头颈癌接受经口机器人手术的28例患者的病历进行了回顾。
经口机器人手术在28例患者中的19例（67.8%）中发现了口咽原发肿瘤。所有口咽原发肿瘤均为p16阳性。舌根识别率为63.2%。术后住院时间中位数为1.0天。96%（27/28）的患者在48小时内恢复正常经口进食。3例患者（10.3%）出现轻微术后出血，均经保守治疗。
本系列中舌根原发肿瘤识别率（63.2%）与先前报道的一致（43%-63%；95%置信区间）。如果患者p16阳性，原发肿瘤识别率为86.3%（19/22），其中100%为口咽肿瘤。我们建议未来研究将p16状态作为对原发灶不明的头颈癌患者进行经口机器人手术分层的一种方法。
经口机器人舌根黏膜切除术（或舌扁桃体切除术）是一种有前景的技术，对原发肿瘤的阳性识别率很高。耐受性良好，相关发病率极低。我们的研究结果与当前文献中的结果相当。
