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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Oral Presentations 4 - Head and Neck Surgery

Preoperative Direct Laryngoscopy vs TORS Alone for Detection of HPV+ Unknown Primary Tumors

Sunday, September 29, 2024
1:06 PM – 1:12 PM EDT
Location: MBCC, 208
Disclosure(s):
Alexander J. Jones, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Peyton Z. Robinson, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Deborah X. Xie, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Janice L. Farlow, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jessica A. Yesensky, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Michael W. Sim, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Patients with squamous cell carcinoma (SCC) of unknown primary often undergo transoral robotic surgery (TORS) for identification of subclinical primary tumors. However, pre-TORS direct laryngoscopy with biopsy (DLBx) may be unnecessary.

Methods: A single-institution, retrospective review of all patients with unknown primary HPV+ SCC undergoing TORS from 2014-2022 was performed. Comparisons of demographics, operations, pathology, staging, adjuvant treatment, and follow up were made between patients receiving pre-TORS DLBx vs TORS alone. Kaplan-Meier curves were generated of 5-year recurrence.

Results: Of the 77 total primarily white (93.5%) male (84.4%) patients, 24 (31.2%) underwent TORS alone. No differences were observed in demographics or clinical staging (all stage I), though those undergoing DLBx were younger (p = 0.006, 61.6 vs 56.3 years). No significant differences were seen in operative time, postoperative stay, or complication rates. Median tumor size was 1.2 cm and most often staged pT1 (68%). The distribution of primary tumor location was largely tonsil and tongue base (81.9%) and similar between groups. Of patients receiving TORS alone, a primary tumor was found in 62.5% compared to 77.4% during TORS after DLBx (p = 0.269). Of tumors identified on TORS, 94.4% had negative final margins vs 88.9% of tumors not identified (p = 0.593). All patients with positive margins (n = 5) had repeat TORS to clear margins. Most patients were ultimately pN1 (70.7%) with overall stage I (81.3%). There were no differences observed between histopathologic findings or staging between groups. There were also no differences in rates and doses of adjuvant radiation. Median follow up was 16.5 months with 6 total cases of recurrence identified at median of 12.5 months. Kaplan-Meier curves did not identify a significant difference in 5-year recurrence between TORS alone vs DLBx groups (p = 0.577).

Conclusions: Pre-TORS DLBx may provide little clinical and oncologic benefit to patients with SCC of unknown primary and be avoided to reduce wasted time and morbidity.

    Presenting Author(s)

  • Alexander J. Jones, MD

    Resident
    Cleveland Clinic
    Cleveland, Ohio, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Peyton Z. Robinson, BS

    Medical Student
    Indiana University School of Medicine
    Terre Haute, IN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Deborah X. Xie, MD

    Fellow
    Indiana University School of Medicine
    Phoenix, AZ, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Janice L. Farlow, MD, PhD

    Assistant Professor
    Indiana University Department of Otolaryngology - Head and Neck Surgery
    Indianapolis, IN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • DC

    David A. Campbell, MD

    Assistant Professor
    Indiana University School of Medicine, United States

    Disclosure information not submitted.

  • JY

    Jessica A. Yesensky, MD

    Assistant Professor of Otolaryngology - Head and Neck Surgery
    Indiana University School of Medicine
    Indianapolis, Indiana, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Michael W. Sim, MD

    Associate Professor
    Indiana University
    Zionsville, IN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.