Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-22T14:16:35.487Z Has data issue: false hasContentIssue false
  • English
  • Français

Tongue base mucosectomy for carcinoma of unknown primary using endoscopic electrocautery: rationale for wider implementation of an institutionally restricted technique

Published online by Cambridge University Press:  20 November 2018

C R Davies-Husband
C R Davies-Husband*
Affiliation:
Department of ENT, Head and Neck Surgery, Royal Sussex County Hospital, Brighton, and Head and Neck Unit, Queen Victoria Hospital, East Grinstead, UK
*
Author for correspondence: Dr C R Davies-Husband, Head and Neck Unit, Queen Victoria Hospital, Holtye Rd, East Grinstead RH19 3DZ, UK E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Cervical metastasis from an unknown primary site invariably results in pan-mucosal irradiation if a primary tumour is not identified. Transoral robotic and laser-assisted mucosectomy are valid techniques to increase diagnostic rates, but these remain restricted to certain centres. This paper describes, in detail, a technique in which mucosectomy is performed via endoscopic electrocautery.

Methods

Patients were prospectively recruited between May 2017 and June 2018. Inclusion criteria stipulated biopsy-proven metastatic cervical squamous cell carcinoma, with negative findings on magnetic resonance imaging and positron emission tomography/computed tomography, in addition to examination under anaesthetic, tonsillectomy and ‘blind’ tongue base biopsies without tumour identification, prior to mucosectomy.

Results

Of nine patients, a mucosal primary was identified in four (44.4 per cent), for which ipsilateral intensity-modulated radiotherapy was advocated in three and completion tongue base resection in the fourth. Dysplasia was demonstrated in two further patients, which provided information relevant to radiotherapy fields and post-treatment surveillance. No surgical complications were identified.

Conclusion

Tongue base mucosectomy using electrocautery and conventional tonsillectomy equipment is a safe, effective technique in the identification of cervical metastasis from an unknown primary site. It expands the potential breadth of use, quickens prolonged diagnostic pathways and obviates the necessity for pan-mucosal irradiation.

Keywords

Unknown PrimaryRobotic Surgical ProceduresEndoscopic Surgical ProceduresElectrocauteryMetastasisCervical CancerSquamous Cell CarcinomaHead And Neck CancerPositron Emission Tomography Computed TomographyRadiotherapy, Intensity-ModulatedXerostomiaDysphagia
Type
Short Communications
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 12 , December 2018 , pp. 1138 - 1142
Copyright
Copyright © JLO (1984) Limited, 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr C R Davies-Husband takes responsibility for the integrity of the content of the paper

References

1Strojan, P, Ferlito, A, Medina, JE, Woolgar, JA, Rinaldo, A, Robbins, KT et al. Contemporary management of lymph node metastases from an unknown primary to the neck: I. A review of diagnostic approaches. Head Neck 2013;35:123–32Google Scholar
2Cianchetti, M, Mancuso, AA, Amdur, RJ, Werning, JW, Kirwan, J, Morris, CG et al. Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Laryngoscope 2009;119:2348–54Google Scholar
3Pattani, KM, Goodier, M, Lilien, D, Kupferman, T, Caldito, G, Nathan, CO. Utility of panendoscopy for the detection of unknown primary head and neck cancer in patients with a negative PET/CT scan. Ear Nose Throat J 2011;90:16–20Google Scholar
4Bhide, SA, Ahmed, M, Newbold, K, Harrington, KJ, Nutting, CM. The role of intensity-modulated radiotherapy in head and neck cancer. Indian J Cancer 2010;47:267–73Google Scholar
5Grau, C, Johansen, LV, Jakobsen, J, Geertsen, P, Andersen, E, Jensen, BB. Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol 2000;55:121–9Google Scholar
6Haas, I, Hoffmann, TK, Engers, R, Ganzer, U. Diagnostic strategies in cervical carcinoma of an unknown primary (CUP). Eur Arch Otorhinolaryngol 2002;259:325–33Google Scholar
7Mehta, V, Johnson, P, Tassler, A, Kim, S, Ferris, RL, Nance, M et al. A new paradigm for the diagnosis and management of unknown primary tumors of the head and neck: a role for transoral robotic surgery. Laryngoscope 2013;123:146–51Google Scholar
8Mackenzie, K, Watson, M, Jankowska, P, Bhide, S, Simo, R. Investigation and management of the unknown primary with metastatic neck disease: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016;130:170–5Google Scholar
9Nagel, TH, Hinni, ML, Hayden, RE, Lott, DG. Transoral laser microsurgery for the unknown primary: role for lingual tonsillectomy. Head Neck 2014;36:942–6Google Scholar
10Tanzler, ED, Amdur, RJ, Morris, CG, Werning, JW, Mendenhall, WM. Challenging the need for random directed biopsies of the nasopharynx, pyriform sinus, and contralateral tonsil in the workup of unknown primary squamous cell carcinoma of the head and neck. Head Neck 2016;38:78–81Google Scholar
11Winter, SC, Ofo, E, Meikle, D, Silva, P, Fraser, L, O'Hara, J et al. Trans-oral robotic assisted tongue base mucosectomy for investigation of cancer of unknown primary in the head and neck region. The UK experience. Clin Otolaryngol 2017;42:1247–51Google Scholar
12Hatten, KM, O'Malley, BW Jr, Bur, AM, Patel, MR, Rassekh, CH, Newman, JG et al. Transoral robotic surgery-assisted endoscopy with primary site detection and treatment in occult mucosal primaries. JAMA Otolaryngol Head Neck Surg 2017;143:267–73Google Scholar