The emerging role of trans-oral robotic surgery for the detection of the primary tumour site in patients with head-neck unknown primary cancers: A meta-analysis

2019 ◽  
Vol 46 (5) ◽  
pp. 663-671 ◽  
Author(s):  
Giuseppe Meccariello ◽  
Giovanni Cammaroto ◽  
Enyinnaya Ofo ◽  
Sebastiano Calpona ◽  
Elisabetta Parisi ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Meta Analysis ◽  
Primary Tumour ◽  
Unknown Primary ◽  
Tumour Site ◽  
Head Neck ◽  
Primary Tumour Site

scholarly journals Survival outcome differences based on treatments used and knowledge of the primary tumour site for patients with cancer of unknown and known primary in Ontario

2018 ◽  
Vol 25 (5) ◽  
Author(s):  
C. S. Kim ◽  
M. B. Hannouf ◽  
S. Sarma ◽  
G. B. Rodrigues ◽  
P. K. Rogan ◽  
...  
Keyword(s):  
Median Survival ◽  
Cox Regression ◽  
Metastatic Cancer ◽  
Primary Tumour ◽  
Primary Site ◽  
Unknown Primary ◽  
Survival Outcomes ◽  
Tumour Site ◽  
Ontario Health Insurance Plan ◽  
Primary Tumour Site

IntroductionPatients with cancer of unknown primary (cup) have pathologically confirmed metastatic tumours with unidentifiable primary tumours. Currently, very little is known about the relationship between the treatment of patients with cup and their survival outcomes. Thus, we compared oncologic treatment and survival outcomes for patients in Ontario with cup against those for a cohort of patients with metastatic cancer of known primary site.Methods Using the Ontario Cancer Registry and the Same-Day Surgery and Discharge Abstract databases maintained by the Canadian Institute for Health Information, we identified all Ontario patients diagnosed with metastatic cancer between 1 January 2000 and 31 December 2005. Ontario Health Insurance Plan treatment records were linked to identify codes for surgery, chemotherapy, or therapeutic radiation related to oncology. Multivariable Cox regression models were constructed, adjusting for histology, age, sex, and comorbidities.Results In 45,347 patients (96.3%), the primary tumour site was identifiable, and in 1743 patients (3.7%), cup was diagnosed. Among the main tumour sites, cup ranked as the 6th largest. The mean Charlson score was significantly higher (p < 0.0001) in patients with cup (1.88) than in those with a known primary (1.42). Overall median survival was 1.9 months for patients with cup compared with 11.9 months for all patients with a known-primary cancer. Receipt of treatment was more likely for patients with a known primary site (n = 35,012, 77.2%) than for those with cup (n = 891, 51.1%). Among patients with a known primary site, median survival was significantly higher for treated than for untreated patients (19.0 months vs. 2.2 months, p < 0.0001). Among patients with cup, median survival was also higher for treated than for untreated patients (3.6 months vs. 1.1 months, p < 0.0001).Conclusions In Ontario, patients with cup experience significantly lower survival than do patients with metastatic cancer of a known primary site. Treatment is associated with significantly increased survival both for patients with cup and for those with metastatic cancer of a known primary site.

Identification of the occult tumor in cancer of unknown primary (CUP): A priority based on histology.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1605-1605 ◽  
Author(s):  
Chong Sung Kim ◽  
Malek Bassam Hannouf ◽  
Muriel Brackstone ◽  
Eric Winquist ◽  
Gregory S Zaric
Keyword(s):  
Cancer Registry ◽  
Primary Tumour ◽  
Cancer Of Unknown Primary ◽  
Rank Test ◽  
Unknown Primary ◽  
Metastatic Tumour ◽  
Tumour Site ◽  
Log Rank Test ◽  
Ontario Cancer Registry ◽  
Primary Tumour Site

1605 Background: The poor prognosis of cancer of unknown primary (CUP) patients is likely to improve with knowledge of the primary site. CUP patients form a diverse clinicopathological group; however, there remains doubt as CUP may indeed represent a unique clinical classification. Methods: We used the Ontario Cancer Registry to identify all patients diagnosed with cancer from January 2000 to December 2005. We linked these patients with the Canadian Institute of Health Information Same Day Surgery and Discharge Abstract Database to identify those who were initially diagnosed with a metastatic tumour. Information on clinical and pathological characteristics including age, gender, primary tumour site, histology, and second primary were available from the Ontario Cancer Registry. We stratified results according to primary tumour site and histology. Five-year survival data were available for all patients and were obtained from the Ontario Cancer Registry. Results: Of 52,619 patients diagnosed with metastatic tumour at the time of their initial cancer diagnosis, 4,866 (9.2%) patients were diagnosed with CUP and 47,753 (90.8%) patients were diagnosed with metastasis of known primary. The 5-year Kaplan-Meier estimate of CUP overall survival (OS) differed significantly with patients diagnosed with metastasis of known primary (median OS= 1.0 versus 10.4 months, respectively, log–rank test p<0.0001). In subgroup analyses, the 5-year OS of CUP patients with adenocarcinoma (n=1,389, median OS=1.83) was significantly worse when compared to metastatic adenocarcinoma of known primary (log-rank test p<0.0001). An identical result was obtained with CUP patients of undifferentiated histology (n=3,230). The 5-year OS of CUP patients with squamous cell carcinoma (n=247, median OS=18.5) did not differ significantly with those of other squamous cell carcinoma groups of known primary (log-rank test p>0.56). Conclusions: Although CUP patients as a whole have a poor prognosis compared to other metastatic patients of known primary, distinct subsets of CUP patients have similar prognosis. These data suggest that an intensive diagnostic approach for identification of the primary is not justified for all CUP patients.

Nutritional status and primary tumour site in incurable cancer

2021 ◽  
pp. bmjspcare-2021-003321
Author(s):  
Livia Costa De Oliveira ◽  
Emanuelly Varea Maria Wiegert ◽  
Lara Azevedo dos Santos ◽  
Larissa Calixto-Lima
Keyword(s):  
Nutritional Status ◽  
Primary Tumour ◽  
Inverse Association ◽  
Gi Tract ◽  
Tumour Site ◽  
Incurable Cancer ◽  
Cross Sectional ◽  
Upper Gi ◽  
Primary Tumour Site ◽  
Upper Gi Tract

ObjectivesWe aimed (1) to assess the nutritional status (NS) using different methods, according to the primary tumour site and (2) to evaluate the performance of these methods in patients with incurable cancer from a reference centre in Brazil.MethodsCross-sectional analysis of data from patients admitted to the palliative care unit of a reference cancer centre in Brazil, between July 2016 and March 2020. The primary tumour site was the independent variable and the NS using different methods were the dependent variables. Logistic regressions were performed.ResultsA total of 2,144 patients were included in the study. The most common primary tumour site was the upper gastrointestinal (GI) tract (18.0%), followed by gynaecological (17.6%) and head and neck (HN) (13.5%). Our results showed that patients with tumours of the upper GI tract followed by HN presented significantly higher risk of worse NS. In contrast, breast tumours, bone and connective tissues and melanoma presented inverse association. The gynaecological cancer was variably associated with nutritional impairment, according to the assessment method.ConclusionsPatients with incurable cancer present high prevalence of NS impairment, depending on the tumour site, shown to be elevated in patients with tumour in the upper GI tract.

Does the prognosis of colorectal mucinous carcinoma depend upon the primary tumour site? Results from two independent databases

2013 ◽  
pp. n/a-n/a ◽  
Author(s):  
Peng Gao ◽  
Yong-xi Song ◽  
Ying-ying Xu ◽  
Zhe Sun ◽  
Jing-xu Sun ◽  
...  
Keyword(s):  
Primary Tumour ◽  
Mucinous Carcinoma ◽  
Tumour Site ◽  
Primary Tumour Site

scholarly journals Transoral robotic surgery for the benefit of patients with head and neck cancer of unknown primary: our experience at St George’s University Hospital, London

2020 ◽  
Vol 102 (6) ◽  
pp. 442-450
Author(s):  
R Mistry ◽  
A Walker ◽  
D Kim ◽  
E Ofo
Keyword(s):  
Robotic Surgery ◽  
Head And Neck ◽  
Primary Tumour ◽  
Head And Neck Carcinoma ◽  
Transoral Robotic Surgery ◽  
Unknown Primary ◽  
Carcinoma Of Unknown Primary ◽  
Identification Rate ◽  
Base Of Tongue ◽  
Neck Carcinoma

Introduction Head and neck carcinoma of unknown primary represents 1–5% of all head and neck cancers and presents a diagnostic and therapeutic dilemma. In approximately 40% of cases, a primary tumour location remains unknown despite investigation. With advancements in our understanding of the role of high-risk human papilloma virus in head and neck cancer, transoral robotic surgery presents an option for diagnosis and therapy. Materials and methods This is a retrospective case series from a single centre. Case notes were reviewed for 28 patients who had transoral robotic surgery for head and neck carcinoma of unknown primary between May 2015 and July 2019. Results Transoral robotic surgery identified an oropharyngeal primary tumour in 19 of 28 (67.8%) patients. All oropharyngeal primaries were p16 positive. The base of tongue identification rate was 63.2%. Median length of inpatient stay postoperatively was 1.0 day. Normal oral intake resumed within 48 hours in 96% (27/28) of patients. Three patients (10.3%) suffered minor postoperative bleeds that were all managed conservatively. Discussion The base of tongue primary identification rate (63.2%) in this series is consistent with that previously reported (43–63%; 95% confidence interval). Primary tumour identification rate if a patient is p16 positive is 86.3% (19/22), with 100% of these being oropharyngeal. We suggest future investigation into p16 status as a means of stratifying patients with head and neck carcinoma of unknown primary for transoral robotic surgery. Conclusion Transoral robotic base of tongue mucosectomy (or lingual tonsillectomy) is a promising technique that offers a high yield of positive identification for the primary tumour. It is well tolerated with minimal associated morbidity. Our findings are comparable with those in the current literature.

Role of transoral robotic surgery in current head & neck practice

The Surgeon ◽  
2017 ◽  
Vol 15 (3) ◽  
pp. 147-154 ◽  
Author(s):  
David Hamilton ◽  
Vinidh Paleri
Keyword(s):  
Robotic Surgery ◽  
Transoral Robotic Surgery ◽  
Head Neck
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