{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T14:58:51Z","timestamp":1785855531309,"version":"3.56.0"},"reference-count":35,"publisher":"Royal College of Surgeons of England","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> Head and neck carcinoma of unknown primary represents 1\u20135% 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. <\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p> 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. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> 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. <\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p> The base of tongue primary identification rate (63.2%) in this series is consistent with that previously reported (43\u201363%; 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. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> 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. <\/jats:p><\/jats:sec>","DOI":"10.1308\/rcsann.2020.0071","type":"journal-article","created":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T15:53:00Z","timestamp":1588175580000},"page":"442-450","source":"Crossref","is-referenced-by-count":16,"title":["Transoral robotic surgery for the benefit of patients with head and neck cancer of unknown primary: our experience at St George\u2019s University Hospital, London"],"prefix":"10.1308","volume":"102","author":[{"given":"R","family":"Mistry","sequence":"first","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, Tooting, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Walker","sequence":"additional","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, Tooting, London, 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