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. 2016 May 4;45(1):28.
doi: 10.1186/s40463-016-0142-6.

The role of transoral robotic surgery, transoral laser microsurgery, and lingual tonsillectomy in the identification of head and neck squamous cell carcinoma of unknown primary origin: a systematic review

Terence S Fu  1 , Andrew Foreman  2 , David P Goldstein  2 , John R de Almeida  3
Affiliations

The role of transoral robotic surgery, transoral laser microsurgery, and lingual tonsillectomy in the identification of head and neck squamous cell carcinoma of unknown primary origin: a systematic review

Terence S Fu et al. J Otolaryngol Head Neck Surg. .

Abstract

Background: Squamous cell carcinoma of the head and neck can present as a cervical metastasis from an unknown primary site. Recently, transoral robotic surgery (TORS) and transoral laser microsurgery (TLM) have been incorporated in the workup of unknown primary tumors.

Methods: We searched MEDLINE, EMBASE, Cochrane, and CINAHL from inception to June 2015 for all English-language studies that utilized TORS, TLM, or lingual tonsillectomy in the approach to an unknown primary.

Results: Of 217 identified studies, eight were reviewed. TORS/TLM identified the primary tumor in 111/139 (80 %) patients overall, and 36/54 (67 %) patients with no remarkable findings following physical exam, radiologic imaging, and panendoscopy with directed biopsies. Lingual tonsillectomy identified the primary tumor in 18/25 (72 %) patients with no findings. Hemorrhage (5 %) was the most common perioperative complication.

Conclusion: Lingual tonsillectomy using new approaches such as TORS/TLM may improve the identification of occult primary tumors.

Keywords: Cervical metastases; Lingual tonsillectomy; TLM; TORS; Unknown primary.

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Figures

Fig. 1
Fig. 1
Selection of studies for systematic review
Fig. 2
Fig. 2
Identification of unknown primary using TORS/TLM in the presence (+) or absence (-) of other findings
Fig. 3
Fig. 3
Identification of unknown primary using lingual tonsillectomy in the presence (+) or absence (-) of other findings. Abbreviations: PE, physical examination; DI, diagnostic imaging; CT, computed tomography; MRI, magnetic resonance imaging; PET, position emitted tomography; EUA, examination under anesthesia with directed biopsy
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