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

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.