What´s new in PubMed this week
Bastit V, Lequesne J, Leconte A, Deneuve S, Mouawad F, Quak E, Jeanne C, Clarisse B, Thariat J. Effectiveness of bilateral tongue base mucosectomy by transoral robotic surgery or transoral laser microsurgery in combination with tonsillectomy in identifying head and neck primary cancer of unknown primary: a randomized phase 2 protocol (RoboCUP trial). BMC Cancer. 2025 Mar 27;25(1):551. doi: 10.1186/s12885-025-13913-7. PMID: 40148848.
This paper presents the RobotCUP trial. It is a French multicentre, open-label, randomized, non-comparative phase 2 trial to evaluate the benefit of bilateral lingual tonsillectomy (TORS or TLM-assisted) in the workup of the unknown primary .
I do have several considerations against.
First and most important. We already do have medical evidence enough to include the base of the tongue in the workup for the unknown primary. Including o control arm with “tonsillectomy alone” (they really mean palatine tonsillectomy) is unethical from my pont of view. Every single patient needs to be individually considered, but most of the cases today are p16+ lymphadenopathies, so you simply cannot ignore the base of the tongue. I know this is not yet usual practice. But it should. Everything afterwards is absurd. Primaries found will likely be T1 and almost all of the patients will be stage I or II, and will not require adjuvant therapy (actually, this is the main reason to make every effort to find the primary and so reduce the toxicity of the treatment).
Why bilateral? We need more space to discuss this.
And to make the story short, again the misunderstanding of some histological and oncologic basics (see the case against lingual mucosectomy).
Jones O, Silva P, Winter SC. Investigating the requirement for nasogastric tube feeding following transoral robotic surgery for head and neck cancer in Oxford: a retrospective cohort study. J Laryngol Otol. 2025 Mar 26:1-17. doi: 10.1017/S0022215125000076. Epub ahead of print. PMID: 40136053.
This is about the functional outcomes. How many patients require a nasogastric feeding tube after TORS? Our rule for oropharyngeal cancer is NOT to use it (and consider in particular cases). Laryngeal cancer is another story.
Han P, Liang F, Li Y, Lin P, Chen R, Lin X, Huang X. Robotic parotidectomy via retroauricular incision: A safe and feasible approach for benign parotid tumors. Oral Oncol. 2025 Mar 24;164:107253. doi: 10.1016/j.oraloncology.2025.107253. Epub ahead of print. PMID: 40132331.
A Chinese paper on this topic. I do not really see the point. The retroauricular incision is the usual approach for parotidectomy, and it is easier without the robot. Let´s talk about this again when the robot makes the surgery itself (not too long for this).
Palma DA, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, Eskander A, Higgins K, Karam I, Poon I, Husain Z, Enepekides D, Hier M, Richardson K, Mlynarek A, Johnson-Obaseki S, Gaudet M, Bayley A, Dowthwaite S, Jackson JE, Dzienis M, O’Neil J, Chandarana S, Banerjee R, Hart R, Chung J, Tenenholtz T, Le H, Yoo J, Mendez A, Winquist E, Kuruvilla S, Stewart P, Warner A, Mitchell S, Chen J, Parker C, Kwan K, Theurer J, Bahig H, Christopoulos A, Mendez LC, Sathya J, Hammond JA, Read N, Venkatesan V, Fung K, Nichols AC. Radiation vs. trans-oral surgery for treatment de-escalation in HPV-related oropharyngeal cancers: Primary analysis of the ORATOR2 randomized trial. Eur J Cancer. 2025 Mar 10;220:115343. doi: 10.1016/j.ejca.2025.115343. Epub ahead of print. PMID: 40121836.
I am really tired about the ORATOR trial. I understand it was a great effort, many people involved, so many time devoted, so expensive… to get so little. No more comments.
Karadaghy OA, Wu MP, Sim ES, Meyer CD, Kumar ATN, Richmon JD. Early Experience With Indocyanine Green (ICG) Fluorescent Guided Transoral Robotic Surgery With the Da Vinci SP. Head Neck. 2025 Mar 21. doi: 10.1002/hed.28135. Epub ahead of print. PMID: 40119552.
Yes, we need to further explore the use of vital fluorescence in H&N Surgery. And it is so easy to use when you already have it integrated in the robotic device. More to come on this, for sure.
Calcano GA, Rourk KS, Routman DM, O’Byrne JJ, Chintakuntlawar AV, Garcia JJ, Price DL, Tasche KK, Moore EJ, Van Abel KM, Yin LX. The Impact of “Close Margins” in HPV-Associated Oropharyngeal Squamous Cell Carcinoma Treated With TORS. Otolaryngol Head Neck Surg. 2025 Apr;172(4):1291-1299. doi: 10.1002/ohn.1127. Epub 2025 Jan 7. PMID: 39764676.
There are so many things we need to redefine related HPV-associated oropharyngeal cancer. The impact of extra-nodal spread, indications for contralateral or elective neck dissections, indications for adjuvant treatment, and of course the impact of close margins (what is a close margin?). All of them have to do with de-scalation.
J Granell. March 30, 2025.
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