Original Investigation |

Robotic Surgery for Primary Head and Neck Squamous Cell Carcinoma of Unknown Site

Sapna A. Patel, MD1; J. Scott Magnuson, MD2,3; F. Christopher Holsinger, MD4; Ron J. Karni, MD5; Jeremy D. Richmon, MD6; Neil D. Gross, MD7; Amit D. Bhrany, MD1; Jay K. Ferrell, MD5; Samuel E. Ford, BS8; Aimee A. Kennedy, MD9; Eduardo Méndez, MD, MS1,10,11
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
2Department of Otolaryngology, University of Alabama–Birmingham Hospital, Birmingham
3Celebration Health Hospital, Kissimmee, Florida
4Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
5Department of Otorhinolaryngology–Head & Neck Surgery, The University of Texas Health Science Center at Houston, Houston
6Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
7Department of Otolaryngology–Head & Neck Surgery, Oregon Health Sciences University, Portland
8University of Alabama–Birmingham Medical School, Birmingham
9Baylor College of Medicine, Houston, Texas
10Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
11Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
JAMA Otolaryngol Head Neck Surg. 2013;139(11):1203-1211. doi:10.1001/jamaoto.2013.5189.
Text Size: A A A
Published online

Importance  Identification of the primary site in head and neck squamous cell carcinoma (HNSCC) is crucial because it improves the patient’s prognosis and minimizes morbidity from treatment.

Objectives  To determine the efficacy of transoral robotic surgery (TORS) in identifying unknown primary sites of head and neck squamous cell carcinoma.

Design, Setting, and Participants  Retrospective, multi-institutional case series from January 1, 2010, to February 28, 2013, in which data were pooled from the following 6 institutions: University of Washington Medical Center, The University of Texas MD Anderson Cancer Center, University of Alabama–Birmingham Hospital, The University of Texas Medical School at Houston, Johns Hopkins Hospital, and Oregon Health Sciences University. All patients diagnosed as having HNSCC of an unknown primary site who underwent TORS to identify the primary site were included in the study. We excluded those with recurrent disease, a history of radiation therapy to the head and neck, or evidence of a primary tumor site based on previous biopsy results.

Main Outcome and Measure  Identification of the primary tumor site.

Results  Forty-seven patients were eligible for the study. The tumor site was identified by TORS in 34 of 47 patients (72.3%). The primary site was located in the base of tongue for 20 patients (58.8%) and the palatine tonsil for 13 patients (38.2%), with 1 patient having a primary site in both the base of tongue and the palatine tonsil. Suspicious physical examination findings were present in 23 of 47 patients (48.9%), with positive and negative predictive values of 56.5% and 25.0%, respectively. Of those who underwent any imaging, 16 patients had suspicious findings, with positive and negative predictive values of 50.0% and 16.7%, respectively. In 18 of 47 patients (38.3%), both preoperative radiographic and physical examination failed to suggest a primary site. Of these 18 patients, 13 (72.2%) were identified after undergoing TORS.

Conclusions and Relevance  We demonstrate that TORS is a useful approach to identify and treat the primary site in patients with HNSCC who present with an unknown primary site.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles