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10.1177/0194599814525746

http://scihub22266oqcxt.onion/10.1177/0194599814525746
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C4167971!4167971!24618502
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suck abstract from ncbi


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pmid24618502      Otolaryngol+Head+Neck+Surg 2014 ; 150 (6): 976-82
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  • Transoral Robotic Surgery and the Unknown Primary: A Cost-Effective Technique to Identify the Tumor #MMPMID24618502
  • Byrd JK; Smith KJ; de Almeida JR; Albergotti WG; Davis KS; Kim SW; Johnson JT; Ferris RL; Duvvuri U
  • Otolaryngol Head Neck Surg 2014[Jun]; 150 (6): 976-82 PMID24618502show ga
  • Objective: To evaluate the cost-effectiveness of transoral robotic surgery (TORS) for diagnosis and treatment of cervical unknown primary squamous cell carcinoma (CUP). Study Design: Retrospective Review Subjects and Methods: A retrospective chart review was performed on patients with new occult primary squamous cell carcinoma of the head and neck with non-diagnostic imaging and/or endoscopy who were treated with TORS at a tertiary hospital between 2009 and 2012. Direct costs ($) were obtained from the hospital?s billing system, and national data were used for inpatient hospital costs and physician fees. The proportion of tumors found in three strategies was used as effectiveness to calculate the incremental cost-effectiveness ratio. Results: 206 head and neck robotic cases were performed at our institution between December 2009 and December 2012. Three surgeons performed TORS on 22 patients for occult primary squamous cell carcinoma. The primary tumor was located in 19/22 (86.4%) patients. The incremental cost-effectiveness ratio for sequential and simultaneous EUA and TORS base of tongue resection was $8619 and $5774 per additional primary identified, respectively. Conclusion: TORS is a cost-effective procedure to locate the primary tumor in patients with cervical lymph node metastases and no obvious source. Bilateral base of tongue resection should be considered as part of the exam under anesthesia for these patients, particularly if the palatine tonsils have already been removed.
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