Jones Alexander J, Robinson Peyton Z, Xie Deborah X, Farlow Janice L, Moore Michael G, Campbell David A, Yesensky Jessica A, Mantravadi Avinash V, Sim Michael W
Department of Otolaryngology-Head and Neck Surgery, Clevleand Clinic, Cleveland, Ohio, USA.
Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Otolaryngol Head Neck Surg. 2025 Aug;173(2):402-409. doi: 10.1002/ohn.1256. Epub 2025 Jun 4.
This study aims to determine whether initial direct laryngoscopy with biopsy (DLBx) before transoral robotic surgery (TORS) has differences in perioperative outcomes, tumor identification, and oncologic outcomes for unknown primary oropharyngeal human papillomavirus (HPV+) squamous cell carcinoma (OPSCC).
A retrospective cohort.
A single-institution, tertiary referral center.
All patients with HPV+ squamous cell carcinoma and unknown primary (cTx) undergoing TORS from 2014 to 2024 were collected. Patients receiving DLBx + TORS versus TORS alone were compared.
A total of 57 patients had no evidence of primary disease on exam, flexible laryngoscopy, and PET/CT imaging, of which 20 (35%) underwent TORS + neck dissection without previous DLBx. Primary tumor was identified on 38% of DLBx and 74% of combined primary and secondary TORS. Only 19% of all cTx patients remained true unknown primary on final pathology (pT0). Demographics and perioperative courses were similar between the two groups. TORS was able to detect primary tumor in the majority of tongue base disease (83%). There were no differences in overall primary tumor size (median 0.8 vs. 1.0 cm), nodal burden, tumor, node, metastasis classification, adjuvant treatment, or 5-year disease-free survival.
Initial DLBx for unknown primary HPV+ OPSCC has similar perioperative and oncologic outcomes to performing initial TORS alone and may unnecessarily delay definitive surgery and add healthcare costs.
IV.
本研究旨在确定在经口机器人手术（TORS）前进行初次直接喉镜检查并活检（DLBx），对于不明原发灶的口咽人乳头瘤病毒（HPV+）鳞状细胞癌（OPSCC）患者，在围手术期结局、肿瘤识别及肿瘤学结局方面是否存在差异。
一项回顾性队列研究。
一家单机构的三级转诊中心。
收集2014年至2024年期间所有接受TORS治疗的HPV+鳞状细胞癌且原发灶不明（cTx）的患者。比较接受DLBx + TORS与单纯接受TORS的患者。
共有57例患者经体格检查、可弯曲喉镜检查及PET/CT成像均未发现原发疾病证据，其中20例（35%）未先行DLBx即接受了TORS + 颈部清扫术。在DLBx中，38%的患者发现了原发肿瘤，而在初次及二次联合TORS中，74%的患者发现了原发肿瘤。在所有cTx患者中，最终病理检查时仅有19%的患者仍为真正的不明原发灶（pT0）。两组患者的人口统计学特征及围手术期过程相似。TORS能够在大多数舌根疾病患者中检测到原发肿瘤（83%）。在总体原发肿瘤大小（中位数0.8 vs. 1.0 cm）、淋巴结负荷、肿瘤-淋巴结-转移分类、辅助治疗或5年无病生存率方面，两组之间没有差异。
对于不明原发灶的HPV+ OPSCC患者，初始进行DLBx与单纯初始进行TORS相比，围手术期及肿瘤学结局相似，且可能不必要地延迟确定性手术并增加医疗成本。
IV级。
