Transoral Robotic Surgery and the Unknown Primary: A Cost-Effective Technique to Identify the Tumor
Identifieur interne : 000A98 ( Main/Exploration ); précédent : 000A97; suivant : 000A99Transoral Robotic Surgery and the Unknown Primary: A Cost-Effective Technique to Identify the Tumor
Auteurs : J. Kenneth Byrd [États-Unis] ; Kenneth J. Smith [États-Unis] ; John R. De Almeida [Canada] ; W. Greer Albergotti [États-Unis] ; Kara S. Davis [États-Unis] ; Seungwon W. Kim [États-Unis] ; Jonas T. Johnson [États-Unis] ; Robert L. Ferris [États-Unis] ; Umamaheswar Duvvuri [États-Unis]Source :
- Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery [ 0194-5998 ] ; 2014.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Analyse coût-bénéfice, Carcinome épidermoïde (), Carcinome épidermoïde (secondaire), Coûts directs des services, Coûts hospitaliers, Femelle, Humains, Interventions chirurgicales robotisées (économie), Mâle, Métastases d'origine inconnue (), Sujet âgé, Tumeurs de la tête et du cou (), Tumeurs de la tête et du cou (secondaire), Études rétrospectives.
- MESH :
- secondaire : Carcinome épidermoïde, Tumeurs de la tête et du cou.
- économie : Interventions chirurgicales robotisées.
- Adulte, Adulte d'âge moyen, Analyse coût-bénéfice, Carcinome épidermoïde, Coûts directs des services, Coûts hospitaliers, Femelle, Humains, Mâle, Métastases d'origine inconnue, Sujet âgé, Tumeurs de la tête et du cou, Études rétrospectives.
English descriptors
- KwdEn :
- Adult, Aged, Carcinoma, Squamous Cell (secondary), Carcinoma, Squamous Cell (surgery), Cost-Benefit Analysis, Direct Service Costs, Female, Head and Neck Neoplasms (secondary), Head and Neck Neoplasms (surgery), Hospital Costs, Humans, Male, Middle Aged, Neoplasms, Unknown Primary (surgery), Retrospective Studies, Robotic Surgical Procedures (economics).
- MESH :
- economics : Robotic Surgical Procedures.
- secondary : Carcinoma, Squamous Cell, Head and Neck Neoplasms.
- surgery : Carcinoma, Squamous Cell, Head and Neck Neoplasms, Neoplasms, Unknown Primary.
- Adult, Aged, Cost-Benefit Analysis, Direct Service Costs, Female, Hospital Costs, Humans, Male, Middle Aged, Retrospective Studies.
Abstract
To evaluate the cost-effectiveness of transoral robotic surgery (TORS) for diagnosis and treatment of cervical unknown primary squamous cell carcinoma (CUP).
Retrospective Review
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.
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.
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.
Url:
DOI: 10.1177/0194599814525746
PubMed: 24618502
PubMed Central: 4167971
Affiliations:
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Le document en format XML
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Kenneth" last="Byrd">J. Kenneth Byrd</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Smith, Kenneth J" sort="Smith, Kenneth J" uniqKey="Smith K" first="Kenneth J." last="Smith">Kenneth J. Smith</name><affiliation wicri:level="2"><nlm:aff id="A2">Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="De Almeida, John R" sort="De Almeida, John R" uniqKey="De Almeida J" first="John R." last="De Almeida">John R. De Almeida</name><affiliation wicri:level="4"><nlm:aff id="A3">Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON</nlm:aff><orgName type="university">Université de Toronto</orgName><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Albergotti, W Greer" sort="Albergotti, W Greer" uniqKey="Albergotti W" first="W. Greer" last="Albergotti">W. Greer Albergotti</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Davis, Kara S" sort="Davis, Kara S" uniqKey="Davis K" first="Kara S." last="Davis">Kara S. Davis</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Kim, Seungwon W" sort="Kim, Seungwon W" uniqKey="Kim S" first="Seungwon W." last="Kim">Seungwon W. Kim</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Johnson, Jonas T" sort="Johnson, Jonas T" uniqKey="Johnson J" first="Jonas T." last="Johnson">Jonas T. Johnson</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Ferris, Robert L" sort="Ferris, Robert L" uniqKey="Ferris R" first="Robert L." last="Ferris">Robert L. Ferris</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh</wicri:cityArea></affiliation></author><author><name sortKey="Duvvuri, Umamaheswar" sort="Duvvuri, Umamaheswar" uniqKey="Duvvuri U" first="Umamaheswar" last="Duvvuri">Umamaheswar Duvvuri</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Pennsylvanie</region></placeName><wicri:cityArea>Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh</wicri:cityArea></affiliation></author></analytic><series><title level="j">Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery</title><idno type="ISSN">0194-5998</idno><idno type="eISSN">1097-6817</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Carcinoma, Squamous Cell (secondary)</term><term>Carcinoma, Squamous Cell (surgery)</term><term>Cost-Benefit Analysis</term><term>Direct Service Costs</term><term>Female</term><term>Head and Neck Neoplasms (secondary)</term><term>Head and Neck Neoplasms (surgery)</term><term>Hospital Costs</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Neoplasms, Unknown Primary (surgery)</term><term>Retrospective Studies</term><term>Robotic Surgical Procedures (economics)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse coût-bénéfice</term><term>Carcinome épidermoïde ()</term><term>Carcinome épidermoïde (secondaire)</term><term>Coûts directs des services</term><term>Coûts hospitaliers</term><term>Femelle</term><term>Humains</term><term>Interventions chirurgicales robotisées (économie)</term><term>Mâle</term><term>Métastases d'origine inconnue ()</term><term>Sujet âgé</term><term>Tumeurs de la tête et du cou ()</term><term>Tumeurs de la tête et du cou (secondaire)</term><term>Études rétrospectives</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Robotic Surgical Procedures</term></keywords><keywords scheme="MESH" qualifier="secondaire" xml:lang="fr"><term>Carcinome épidermoïde</term><term>Tumeurs de la tête et du cou</term></keywords><keywords scheme="MESH" qualifier="secondary" xml:lang="en"><term>Carcinoma, Squamous Cell</term><term>Head and Neck Neoplasms</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Carcinoma, Squamous Cell</term><term>Head and Neck Neoplasms</term><term>Neoplasms, Unknown Primary</term></keywords><keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Interventions chirurgicales robotisées</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Cost-Benefit Analysis</term><term>Direct Service Costs</term><term>Female</term><term>Hospital Costs</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Retrospective Studies</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse coût-bénéfice</term><term>Carcinome épidermoïde</term><term>Coûts directs des services</term><term>Coûts hospitaliers</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Métastases d'origine inconnue</term><term>Sujet âgé</term><term>Tumeurs de la tête et du cou</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title><p id="P1">To evaluate the cost-effectiveness of transoral robotic surgery (TORS) for diagnosis and treatment of cervical unknown primary squamous cell carcinoma (CUP).</p></sec><sec id="S2"><title>Study Design</title><p id="P2">Retrospective Review</p></sec><sec id="S3"><title>Subjects and Methods</title><p id="P3">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.</p></sec><sec id="S4"><title>Results</title><p id="P4">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.</p></sec><sec id="S5"><title>Conclusion</title><p id="P5">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.</p></sec></div></front></TEI><affiliations><list><country><li>Canada</li><li>États-Unis</li></country><region><li>Ontario</li><li>Pennsylvanie</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="États-Unis"><region name="Pennsylvanie"><name sortKey="Byrd, J Kenneth" sort="Byrd, J Kenneth" uniqKey="Byrd J" first="J. Kenneth" last="Byrd">J. Kenneth Byrd</name></region><name sortKey="Albergotti, W Greer" sort="Albergotti, W Greer" uniqKey="Albergotti W" first="W. Greer" last="Albergotti">W. Greer Albergotti</name><name sortKey="Davis, Kara S" sort="Davis, Kara S" uniqKey="Davis K" first="Kara S." last="Davis">Kara S. Davis</name><name sortKey="Duvvuri, Umamaheswar" sort="Duvvuri, Umamaheswar" uniqKey="Duvvuri U" first="Umamaheswar" last="Duvvuri">Umamaheswar Duvvuri</name><name sortKey="Ferris, Robert L" sort="Ferris, Robert L" uniqKey="Ferris R" first="Robert L." last="Ferris">Robert L. Ferris</name><name sortKey="Johnson, Jonas T" sort="Johnson, Jonas T" uniqKey="Johnson J" first="Jonas T." last="Johnson">Jonas T. Johnson</name><name sortKey="Kim, Seungwon W" sort="Kim, Seungwon W" uniqKey="Kim S" first="Seungwon W." last="Kim">Seungwon W. Kim</name><name sortKey="Smith, Kenneth J" sort="Smith, Kenneth J" uniqKey="Smith K" first="Kenneth J." last="Smith">Kenneth J. Smith</name></country><country name="Canada"><region name="Ontario"><name sortKey="De Almeida, John R" sort="De Almeida, John R" uniqKey="De Almeida J" first="John R." last="De Almeida">John R. De Almeida</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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