Department of Otolaryngology/Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Otorhinolaryngology, University of Bari, Bari, Italy.
Clin Otolaryngol. 2020 Sep;45(5):732-738. doi: 10.1111/coa.13565. Epub 2020 May 25.
Transoral robotic surgery (TORS) is increasingly used in head and neck surgery and in carcinoma of unknown primary (CUP) origin specifically. Due to the rising incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC), there is a rationale for finding ways to de-escalate treatment strategies. This review aims to test the hypothesis that TORS is a meaningful adjunct in the diagnostic (and therapeutic) pathway in CUP in head and neck.
A structured search of the literature was performed with the search terms 'TORS' and 'Carcinoma of Unknown Primary'.
Two hundred and seventy four cases of CUP in which TORS was used were identified for further analysis. Workup for CUP was comparable in all series with regard to physical examination, fine and/or gross needle examination of cervical nodes, fibre optic endoscopy, imaging and robot assisted mucosectomy of the base of tongue (BOT). Identification rate of the primary tumour was 72% on average (range 17%- 90%), and 55%- 96% were HPV positive. Clear margins were achieved in 60% (range 0%-85%) of resected occult tumours. Complication rate of TORS BOT mucosectomy was low with mainly grade I-III sequelae according to Clavien-Dindo.
Transoral robotic surgery seems to be a useful and safe adjunct in the diagnostic and therapeutic pathway in case of CUP in an era of increasing incidence of HPV-positive OPSCC.
经口机器人手术（TORS）越来越多地用于头颈部手术和不明原发灶的癌（CUP）中，尤其是 HPV 相关的口咽鳞状细胞癌（OPSCC）发病率上升。因此，寻找降低治疗策略的方法是合理的。本综述旨在检验 TORS 作为头颈部 CUP 诊断（和治疗）途径的辅助手段的假设。
使用“TORS”和“Carcinoma of Unknown Primary”这两个术语对文献进行了结构化搜索。
为进一步分析，共确定了 274 例使用 TORS 的 CUP 病例。所有系列的 CUP 检查均相似，包括体格检查、颈部淋巴结细针和/或粗针检查、纤维光学内窥镜检查、影像学检查和机器人辅助舌根基底粘膜切除术（BOT）。平均而言，TORS 检测原发肿瘤的识别率为 72%（范围为 17%-90%），55%-96%为 HPV 阳性。切除隐匿性肿瘤的切缘均为阴性（范围为 0%-85%）。TORS BOT 粘膜切除术的并发症发生率较低，根据 Clavien-Dindo 分级主要为 1-3 级后遗症。
在 HPV 阳性 OPSCC 发病率不断上升的时代，TORS 似乎是 CUP 诊断和治疗途径中的一种有用且安全的辅助手段。
