Head & Neck Surgical Oncology Unit, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.
Department of Otorhinolaryngology and Head and Neck Surgery, Walsall Manor Hospital, Walsall, UK.
Ann Surg Oncol. 2024 Sep;31(9):6065-6076. doi: 10.1245/s10434-024-15758-z. Epub 2024 Jul 9.
Head and neck carcinoma of unknown primary (CUP) represents a challenging diagnostic process when standard work-up fails to identify the primary tumour site. The aim of this systematic review and meta-analysis was to evaluate the diagnostic utility and complication profile of transoral robotic surgery (TORS) tongue base mucosectomy (TBM) in the management of CUP.
An electronic database search was performed in the EMBASE, MEDLINE, PubMed and Cochrane databases. A meta-analysis of proportions was performed to obtain an estimate of the overall proportion for the detection and complication rates.
Nine studies representing 235 patients with CUP who had TORS TBM were included in the final analysis. The overall pooled tumour detection rate was 66.2% [95% confidence interval (CI) 56.1-75.8]. The incidence of tumour detection in human papilloma virus (HPV)-positive cases (81.5%, 95% CI 60.8-96.4) was significantly higher than HPV-negative cases (2.3%, 95% CI 0.00-45.7). Weighted overall complication rate was 11.4% (95% CI 7.2-16.2). The majority were grade I or II (80%) according to the Clavien-Dindo classification.
This meta-analysis suggests TORS to be safe and effective in localising the primary tumour site in patients with CUP. While the current data supports the use of TORS in patients who are HPV positive, larger numbers of HPV-negative cases are required to determine the true diagnostic effect with TORS before any valid conclusions can be inferred in this particular subgroup. Further research should focus on high quality prospective trials with stringent methodological work-up to minimise heterogeneity and allow for more accurate statistical analysis.
当标准检查未能确定原发性肿瘤部位时，头颈部不明原发癌（CUP）代表了一个具有挑战性的诊断过程。本系统评价和荟萃分析的目的是评估经口机器人手术（TORS）舌底黏膜切除术（TBM）在 CUP 管理中的诊断效用和并发症谱。
在 EMBASE、MEDLINE、PubMed 和 Cochrane 数据库中进行电子数据库搜索。进行了比例的荟萃分析，以获得总体检出率和并发症发生率的估计值。
共有 9 项研究纳入了 235 例接受 TORS TBM 的 CUP 患者，最终纳入了分析。总体肿瘤检出率为 66.2%（95%置信区间 56.1-75.8）。HPV 阳性病例（81.5%，95%置信区间 60.8-96.4）的肿瘤检出率明显高于 HPV 阴性病例（2.3%，95%置信区间 0.00-45.7）。加权总并发症发生率为 11.4%（95%置信区间 7.2-16.2）。根据 Clavien-Dindo 分类，大多数为 1 级或 2 级（80%）。
这项荟萃分析表明，TORS 安全且有效地定位 CUP 患者的原发性肿瘤部位。虽然目前的数据支持在 HPV 阳性患者中使用 TORS，但需要更多的 HPV 阴性病例来确定 TORS 的真正诊断效果，以便在这一特定亚组中得出任何有效结论。进一步的研究应侧重于高质量的前瞻性试验，并严格进行方法学检查，以尽量减少异质性并允许更准确的统计分析。
