The Role of Trans Oral Robotic Surgery in the Carcinoma of Unknown Primary: A New Evidence in the Horizon?

Karthika Chettuvatti; Naresh Kumar Panda; Jaimanti B Bakshi; Roshan K Verma; Gyan Ranjan Nayak; Nitika Goel; Ashim Das; Anish Bhattacharya; Anupam Mittal; Manish Rohilla

doi:10.1007/s12070-023-04460-3

The Role of Trans Oral Robotic Surgery in the Carcinoma of Unknown Primary: A New Evidence in the Horizon?

Indian J Otolaryngol Head Neck Surg. 2024 Apr;76(2):1941-1948. doi: 10.1007/s12070-023-04460-3. Epub 2024 Jan 8.

Affiliations

¹ Department of Otorhinolaryngology and Head-Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
² Department of Anaesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
³ Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
⁴ Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
⁵ Department of Translational and Regenerative Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
⁶ Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

PMID: 38566719
PMCID: PMC10982237 (available on 2025-04-01)
DOI: 10.1007/s12070-023-04460-3

Abstract

The detection of the primary site in Carcinoma of Unknown Primary (CUP) is a challenging task which can significantly alter the course of management and also prognosis. Various modalities have been assessed with varying sensitivity and specificity. Imaging and cytological diagnosis have formed a key part of the diagnostic algorithm of CUP. Trans Oral Robotic Surgery offers the advantage of being both diagnostic as well as therapeutic with promising sensitivity and specificity and can form an integral part in the management of CUP. A prospective study was carried out at a tertiary care centre over a period of one year. Patients with unilateral neck swelling which was histopathologically proven squamous cell carcinoma neck metastasis were included in the study. They were evaluated with endoscopy and radiology according to the standard algorithm. When these failed to detect the primary, the patients underwent ipsilateral radical tonsillectomy and tongue base mucosal wedge biopsy via TORS. Post-operative histopathological examination was done on the resected specimens to detect the primary site. Transoral Robotic Surgery was able to localise primary in 50% of the patients enrolled in the study. Out of the primary site identified by TORS; 55.56% were located in the tonsil and 44.4% in the tongue base. TORS can offer promising detection rates of the occult primary in CUP and should form an integral part of the diagnostic algorithm.

Keywords: Carcinoma of unknown primary; Head and neck cancer; Oropharyngeal cancer; Palatine tonsillectomy; Robotic surgery; Tongue base mucosectomy; Tongue cancers; Tonsillar neoplasm; Transoral robotic surgery; Unknown primary neoplasms.

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