Evidence map›Paper›PMID 40468647›Full record

ArticleOtolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery2025

Initial Direct Laryngoscopy Versus TORS Alone for Unknown Primary HPV+ Oropharyngeal Squamous Cell Carcinoma.

Alexander J Jones, Peyton Z Robinson, Deborah X Xie, Janice L Farlow, Michael G Moore, David A Campbell, Jessica A Yesensky, Avinash V Mantravadi, Michael W Sim

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Alexander J JonesDepartment of Otolaryngology-Head and Neck Surgery, Clevleand Clinic, Cleveland, Ohio, USA.ORCID https://orcid.org/0000-0002-9219-285X
Peyton Z RobinsonDepartment of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.ORCID https://orcid.org/0000-0002-0507-0900
Deborah X XieDepartment of ENT and Skull Base Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.ORCID http://orcid.org/0000-0002-3949-199X
Janice L FarlowDepartment of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.ORCID http://orcid.org/0000-0003-1214-4960
Michael G MooreDepartment of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
David A CampbellDepartment of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Jessica A YesenskyDepartment of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.ORCID http://orcid.org/0000-0002-1558-9693
Avinash V MantravadiDepartment of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.ORCID http://orcid.org/0000-0002-7971-481X
Michael W SimDepartment of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.ORCID http://orcid.org/0000-0001-6571-9452

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThis study aims to determine whether initial direct laryngoscopy with biopsy (DLBx) before transoral robotic surgery (TORS) has differences in perioperative outcomes, tumor identification, and oncologic outcomes for unknown primary oropharyngeal human papillomavirus (HPV+) squamous cell carcinoma (OPSCC). STUDY

designA retrospective cohort.

settingA single-institution, tertiary referral center.

methodsAll patients with HPV+ squamous cell carcinoma and unknown primary (cTx) undergoing TORS from 2014 to 2024 were collected. Patients receiving DLBx + TORS versus TORS alone were compared.

resultsA total of 57 patients had no evidence of primary disease on exam, flexible laryngoscopy, and PET/CT imaging, of which 20 (35%) underwent TORS + neck dissection without previous DLBx. Primary tumor was identified on 38% of DLBx and 74% of combined primary and secondary TORS. Only 19% of all cTx patients remained true unknown primary on final pathology (pT0). Demographics and perioperative courses were similar between the two groups. TORS was able to detect primary tumor in the majority of tongue base disease (83%). There were no differences in overall primary tumor size (median 0.8 vs. 1.0 cm), nodal burden, tumor, node, metastasis classification, adjuvant treatment, or 5-year disease-free survival.

conclusionInitial DLBx for unknown primary HPV+ OPSCC has similar perioperative and oncologic outcomes to performing initial TORS alone and may unnecessarily delay definitive surgery and add healthcare costs. LEVEL OF EVIDENCE: IV.

Indexed as

Carcinoma, Squamous CellLaryngoscopyNeoplasms, Unknown PrimaryOropharyngeal NeoplasmsPapillomavirus InfectionsRobotic Surgical ProceduresSquamous Cell Carcinoma of Head and NeckAgedBiopsyFemaleHumansMaleMiddle AgedRetrospective Studiesdirect laryngoscopyhead and neck cancerHPV+ squamous cell carcinomatransoral robotic surgeryunknown primary

Identifiers

PMID40468647
PMCPMC12312296

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.