Precision and Pitfalls: A Prospective Study Analysing the Immediate Postoperative Sequelae and Oncological Outcome of TORS When Used in Diagnostic Algorithm of Carcinoma Unknown Primary.

Abstract

With the realm of carcinoma unknown primary, incorporating Trans Oral Robotic Surgery represents the diagnostic frontier. This study emphasises the immediate postoperative sequelae and also oncological outcome of patients who underwent TORS to diagnose the primary site in unknown primary carcinoma and assesses the feasibility in the Indian scenario. A prospective study was carried out at a tertiary care centre over two years (January 2020 to January 2022). Patients underwent TORS-assisted ipsilateral radical tonsillectomy, tongue base mucosal wedge biopsy and neck dissection as a part of the diagnostic algorithm of carcinoma unknown primary. The postoperative complications, need for nasogastric feeding, need for tracheostomy, return to oral diet and duration of hospital stay were assessed in these patients. Oncological outcomes were assessed in the same population with the median follow up duration of 49 months. The study encompassed a group of 18 patients of Carcinoma Unknown Primary (CUP) who underwent a comprehensive set of procedures, including ipsilateral radical tonsillectomy, mucosal tongue base wedge biopsy, and neck dissection for the identification of the primary site. The average duration of inpatient stay post-surgical procedure was 3.33 ± 0.57 days. A late postoperative complication of Transoral Robotic Surgery (TORS) manifested as minor intraoral bleeding in 11.1% of patients (n = 2/18). An immediate postoperative complication related to neck dissection, specifically neck hematoma, occurred in 11.76% of patients (n = 2/17). Tracheostomy and nasogastric feeds were implemented for a short period in only 5.9% of patients (n = 1/17). Survival analysis conducted on the same population, with a median follow-up of 33 months, revealed no differences in Overall Survival (OS) and Disease-Free Survival (DFS) concerning primary site identification and HPV positivity. Transoral Robotic Surgery (TORS) with concurrent neck dissection proves to be an effective diagnostic and concurrent treatment option for patients with Carcinoma of unknown primary (CUP) with secondary squamous cell neck metastasis. This minimally invasive approach shows a 3-year overall survival rate of 88.69% and a disease-free survival rate of 89.12% with median follow up duration of 33 months.