Journal
JOURNAL OF OTOLARYNGOLOGY-HEAD & NECK SURGERY
Volume 45, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s40463-016-0142-6
Keywords
Unknown primary; TORS; TLM; Lingual tonsillectomy; Cervical metastases
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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.
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