title: Trans-oral robotic assisted tongue base mucosectomy for investigation of cancer of unknown primary in the head and neck region. The UK experience.
abstract: OBJECTIVE
  The diagnosis of cancer of unknown primary (CUP) in head and neck occurs when the treating clinicians have utilised all available diagnostic tests and failed to identify the origin of the disease. There is no agreed consensus on which diagnostic investigations to use, or the order in which to use them in, although broad recommendations exist. Small tumours arising in the tongue base can be below the limits of resolution of conventional diagnostic techniques. Given the difficulty in targeting the tongue base, current practice involves blind random biopsies, which leads to a variable detection rate. Robotically assisted surgical removal of the tongue base, tongue base mucosectomy (TBM) has been shown to improve diagnostic yield. This study reports the diagnostic hit rate for tongue base primaries using this technique.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  UK Head and Neck Centres.
  
  
  METHODS
  Patients presenting as an unknown primary, investigated with clinical examination, PET-CT and palatine tonsillectomy.
  
  
  METHODS
  The detection of a primary site of head and neck cancer in the otherwise unknown primary tumour.
  
  
  RESULTS
  The primary tumour site was identified in the tongue base in 53% (n=17) of patients. In 15 patients the tumour was in the ipsliateral tongue base (88%) while in two cases (12%) the tumour was located in contra lateral tongue base.
  
  
  CONCLUSIONS
  Trans-oral robotic assisted TBM raises the possibility of identifying over 50% of tumours that would otherwise be classified as CUP. Identifying these in the contralateral tongue base has implications for treatment planning and outcome.
authors.affiliation: Oxford University NHS Trusts, Oxford, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Winter
authors.affiliation: St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Ofo
authors.affiliation: Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
authors.forename: D
authors.initials: D
authors.lastname: Meikle
authors.affiliation: Oxford University NHS Trusts, Oxford, UK.
authors.forename: P
authors.initials: P
authors.lastname: Silva
authors.affiliation: Oxford University NHS Trusts, Oxford, UK.
authors.forename: L
authors.initials: L
authors.lastname: Fraser
authors.affiliation: Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
authors.forename: J
authors.initials: J
authors.lastname: O'Hara
authors.affiliation: St George's University Hospitals NHS Foundation Trust, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Kim
authors.affiliation: Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.
authors.forename: M
authors.initials: M
authors.lastname: Robinson
authors.affiliation: Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK.|Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: V
authors.identifier: http://orcid.org/0000-0002-7933-4585
authors.initials: V
authors.lastname: Paleri
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000556:secondary* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000601:surgery; D000072078:Positron Emission Tomography Computed Tomography; D065287:Robotic Surgical Procedures; D000077195:Squamous Cell Carcinoma of Head and Neck; D014062:Tongue Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D006113:United Kingdom
keywords: Trans-Oral Robotic Surgery (TORS); head and neck; robotic; unknown primary