Transoral Robotic Surgery-Assisted Endoscopy with Primary Site Detection for Occult Mucosal Primaries – 2 year survival

Presentation: C135
Topic: Survivorship
Type: Poster
Date: Thursday, April 19, 2018
Session: 9:00 AM - 7:00 PM
Authors: Karthik Rajasekaran, MD, Neslihan Yarpkak, MD, Jason Adleberg, BSE, Bert W O'Malley, MD, Jason Newman, MD, Steven Cannady, MD, Ara Chalian, MD, Christopher Rassekh, MD, Alexander Lin, MD, John Lukens, MD, Samuel Swisher-Mcclure, MD, Roger Cohen, MD, Charu Aggarwal, MD, Joshua Bauml, MD, Gregory S Weinstein, MD
Institution(s): University of Pennsylvania

Importance: Treatment of patients with squamous cell carcinoma of unknown primary (CUP) is challenging.  Use of transoral robotic surgery (TORS) allows for an improved rate of detection of the primary and in many instances avoidance of radiation and chemotherapy.

Objective: To evaluate the disease-free survival and overall survival of patients presenting with CUP, who underwent TORS assisted endoscopy for identification of the primary tumor.  In addition, to evaluate the long-term survival of the select patients with treatment deintensification.

Design: Retrospective case series from January 2011 to September 2015.

Setting: Tertiary care academic medical center

Participants: 60 consecutive patients with squamous cell CUP who underwent TORS-assisted endoscopy and ipsilateral neck dissection.

Main Outcomes and Measures: Disease free survival and overall survival.  

Results: 60 patients were included in the study. The mean age was 55.5 years.  55 patients (92%) were positive for HPV-related squamous cell carcinoma.  2-year overall survival was 93.3% (56 patients) and disease specific survival was 96.7% (58 patients). Among the 4 patients who did not survive, 1 patient had a perioperative cardiopulmonary event while ambulating 3 days following secondary TORS hemiglossectomy, 1 patient had regional failure, 1 patient had distant failure to the lung and 1 patient died of other causes.  Among the 40 (67%) patients who did not receive chemotherapy, and the 15 (25%) who did not receive radiation therapy in this study, all are disease free and alive to date. 

Conclusions and Relevance: Our prior work established the efficacy of a TORS-assisted endoscopic approach to identify and surgically treat patients presenting with squamous cell CUP.  Additionally, we proposed that select patients based on the pathology, could benefit from treatment deintensification by eliminating need for chemotherapy and radiation therapy.  The survival data from that series demonstrates that this novel surgical approach not only improves identification of occult mucosal malignancies but can also eliminate the need for chemotherapy as well as radiation therapy in select patients.