title: 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.
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.
  
  
  CONCLUSIONS
  Lingual tonsillectomy using new approaches such as TORS/TLM may improve the identification of occult primary tumors.
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Terence S
authors.initials: TS
authors.lastname: Fu
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Foreman
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada. john.dealmeida@uhn.ca.
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy; D008866:Microsurgery; D009382:Neoplasms, Unknown Primary / Q000473:pathology*; D065287:Robotic Surgical Procedures; D014068:Tonsillectomy
keywords: Cervical metastases; Lingual tonsillectomy; TLM; TORS; Unknown primary