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

Abstract

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 extensive investigation including imaging, tonsillectomy, panendoscopy and tissue biopsy. Treatment typically involves neck dissection, wide field radiotherapy and chemotherapy. Transoral robotic surgery (TORS) has emerged as an expanding surgical technique for resecting tumours of the oropharynx. Its role in base of tongue (BOT) mucosectomy for HNCUP can alleviate diagnostic uncertainty and provide an adjunct treatment modality with few complications. We conducted a 7-year chart review of consecutive patients presenting with HNCUP that were treated with TORS BOT mucosectomy. We examined the efficacy, diagnostic rates and complications associated with TORS BOT mucosectomy when used for treating HNCUP. TORS BOT mucosectomy was performed in seven cases of squamous cell carcinoma of unknown primary. Robotic mucosectomy diagnosed BOT as the primary tumour site in five cases (71.4%). All five cases were p16 positive. Average time before return to normal swallowing function was 2.7 days. There were no major surgical complications. TORS BOT mucosectomy is an expanding surgical technique with a key role in head and neck surgery. It can be utilized to good effect where head and neck cancer is diagnosed without an identifiable primary. Incorporating robotic surgery in the diagnostic and treatment pathway offers low complication rates, reduced morbidity and improved tumour identification.