经口机器人手术(TORS)和激光显微手术(TLM)在诊断和识别未知原发部位中的使用已变得越来越普遍。本系统评价和荟萃分析旨在评估TORS和TLM对该适应症的使用和疗效。
使用TORS或TLM诊断鳞状细胞来源的宫颈淋巴结转移患者原发肿瘤部位未知的研究的系统评价和荟萃分析。MEDLINE,从开始到2018年7月,对EMBASE和CINHAL进行了搜索,以寻找所有使用TORS和/或TLM识别未知原发的研究。
确定了251项研究,其中21人符合入选条件。在78%的患者中通过TORS/TLM鉴定出原发性肿瘤(556例中的433例)。舌基粘膜切除术(TBM)在427例中的222例中确定了原发性(53%)。体检阴性的患者,诊断成像和PETCT,TBM在64%(95%CI50,79)的病例中确定了原发性。在CT/MRI成像阴性的患者中,PETCT阴性和EUA阴性和扁桃体切除术,TBM在78%(95%CI41,92)的病例中发现舌根原发性。出血,最常见的并发症,在4.9%的病例中报告。平均住院时间在1.4到6.3天之间变化。
舌基粘膜切除术,由TORS或TLM执行,在识别头颈部区域的未知原发中非常有效。
The use of transoral robotic surgery (TORS) and laser microsurgery (TLM) in the diagnosis and identification of the site of the unknown primary has become increasingly common. This systematic review and meta-analysis aims to assess the use and efficacy of TORS and TLM for this indication.
Systematic review and meta-analysis of studies employing TORS or TLM in diagnosis of the unknown primary tumor site in patients with cervical nodal metastases of squamous cell origin. MEDLINE, EMBASE and CINHAL were searched from inception to July 2018 for all studies that used TORS and or TLM in identifying the unknown primary.
251 studies were identified, of which 21 were eligible for inclusion. The primary tumour was identified by TORS/TLM in 78% of patients (433 out of 556). Tongue base mucosectomy (TBM) identified the primary in 222 of 427 cases (53%). In patients with negative physical examination, diagnostic imaging and PETCT, TBM identified the primary in 64% (95% CI 50, 79) cases. In patients who had negative CT/MRI imaging, negative PETCT and negative EUA and tonsillectomy, TBM identified a tongue base primary in 78% (95% CI 41, 92) cases. Haemorrhage, the commonest complication, was reported in 4.9% cases. Mean length of stay varied between 1.4 and 6.3 days.
Tongue base mucosectomy, performed by TORS or TLM, is highly efficacious in identifying the unknown primary in the head and neck region.