Diagnosis and prognosis of different methods of tongue base mucosectomy for occult head and neck cancer: A systematic review and meta-analysis.

Trans-oral robotic surgery (TORS) and trans-oral laser microsurgery (TLM) have been increasingly employed for the diagnosis and identification of primary occult cancers in the head and neck region. This systematic review and meta-analysis aimed to evaluate the application and effectiveness of tonsillectomy with TORS and TLM in detecting these cancers. We searched PubMed, EMBASE, and the Cochrane Library for eligible studies using TORS or TLM in identifying the unknown primary sites of occult head and neck cancer, published from inception to September 2023. Two investigators independently screened articles based on inclusion and exclusion criteria. From 2282 articles identified, 20 individual studies meeting the inclusion criteria were included in this meta-analysis. Primary tumors were identified by TORS/TLM in 65% (364/561) of patients. The initial identification rates of lingual tonsillectomy (n = 219) and palatine tonsillectomy (n = 83) were 39% and 15%, respectively. The identification rates of primary sites for trans-oral surgical techniques were 60.7% (95% CI, 49.4-72%) for TORS and 75.7% (95% CI, 60.7-90.7%) for TLM. Seventy-nine point six percent (467/587) of the tumors were associated with human papilloma virus (HPV). The detection rate of HPV+ tumors was 79% (173/220) and the detection rate of HPV- tumors was 10% (5/52). The most common complication was nasogastric/gastrostomy, accounting for 6% (29/481). The length of hospital stay reported varied from 1 to more than 7 days. This is a latest systematic review of the detection rates of head and neck squamous cell carcinoma of unknown primary sites by tongue base mucosectomy (TBM) via TORS and TBM via TLM. This study confirmed that TBM via TLM performed better than TBM-TORS in the detection rate of the primary. In particular, TBM via TLM showed significant advantages in detecting primary lesions in HPV-positive head and neck squamous cell carcinoma of unknown primary patients.

Wang D ，Zou T ，Gao T ，Yao Y ，Liu C ，Wang Y ，Lu H ，Yu H ，Wang Q ，Song J ... -  《-》

Step Serial Sectioning in Head and Neck Squamous Cell Carcinoma of Unknown Primary.

Hardman JC ，Harrington K ，O'Leary B ，Robinson M ，Paleri V ... -  《-》

The value of tongue base mucosectomy in the work-up of squamous cell carcinoma of unknown primary: A Danish national cohort study.

Squamous cell carcinoma of unknown primary in the head and neck (HNSCCUP) remains a diagnostic challenge. Tongue base mucosectomy by transoral robotic surgery (TORS-TBM) can increase the diagnostic yield and de-intensify treatment. However, the added value of TORS-TBM as an adjunct to work-up programs for HNSCCUP is unclear. Furthermore, the optimal extent of the procedure and selection criteria remain to be established. The primary aim of the present study was to assess the diagnostic yield of TORS-TBM as a supplement to a standardized work-up program, using the Danish national guidelines as an example. Secondary aims include predictive values of HPV-testing and PET/CT. This was a national multicenter observational cohort study including all patients diagnosed with HNSCCUP from January 2013 to December 2019, who subsequently underwent TORS-TBM. In most cases HPV status was based on dual testing (p16 and HPV-DNA). Predictive values of PET/CT and HPV status were calculated. A total of 100 consecutive patients underwent TORS-TBM; 93 total TBMs and 7 unilateral TBMs. The primary tumor was detected in 49 % (49/100) of patients. The detection rate was 58 % (47/81) in patients with HPV-associated disease (PPV of HPV status) and 11 % (2/19) in patients with HPV-independent disease. The NPV of HPV status was 89 %. The PPV and NPV of PET/CT was 53 % and 52 %, respectively. Adding total TORS-TBM to the current Danish guideline-based work-up program on HNCCCUP patients with HPV-associated disease significantly improved the diagnostic yield.

Nielsen SB ，Holm Larsen MH ，Channir HI ，Kiss K ，Parm Ulhøi B ，Godballe C ，Grau Eriksen J ，Rubek N ，Kjaergaard T ，von Buchwald C ... -  《-》

The Role of Transoral Robotic Palatine and Lingual Tonsillectomy in the Diagnosis of Carcinoma of Unknown Primary in the Head and Neck Region.

The use of transoral robotic surgery (TORS) lingual tonsillectomy in the diagnostic algorithm for head and neck carcinoma of unknown primary (CUP) has gained recent popularity. The primary aim of our study was to determine the identification rate of primary tumors in our cohort undergoing lingual ± palatine tonsillectomy for the workup of head and neck CUP. This was a retrospective study of all patients undergoing diagnostic TORS for head and neck CUP over an eight-year period, across four centers in two countries. Fifty-six patients undergoing TORS to aid diagnosis of a primary site were included. Overall, TORS lingual ± palatine tonsillectomy identified a primary tumor in 41 (73.2%) patients. Over half were T1 tumors, with 25% measuring under 10 mm. Among those with human papilloma virus (HPV)+ nodal disease, the identification rate was 82.6%. TORS lingual tonsillectomy is an effective addition to the diagnostic workup of CUP, particularly in those with HPV+ nodal disease.

Mc Loughlin L ，Zhang H ，Blom M ，Walsh M ，Moran T ，Dixon B ，Magarey M ，O'Duffy F ... -  《-》

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling.

Elwenspoek MM ，Thom H ，Sheppard AL ，Keeney E ，O'Donnell R ，Jackson J ，Roadevin C ，Dawson S ，Lane D ，Stubbs J ，Everitt H ，Watson JC ，Hay AD ，Gillett P ，Robins G ，Jones HE ，Mallett S ，Whiting PF ... -  《-》