当标准检查无法识别原发肿瘤部位时，原发不明头颈癌 (CUP) 是一个具有挑战性的诊断过程。本系统综述和荟萃分析的目的是评估经口机器人手术 (TORS) 舌底粘膜切除术 (TBM) 在 CUP 治疗中的诊断效用和并发症情况。在 EMBASE、MEDLINE、 PubMed 和 Cochrane 数据库。对比例进行荟萃分析，以获得检测和并发症发生率的总体比例的估计。最终分析中纳入了代表 235 名接受 TORS TBM 的 CUP 患者的 9 项研究。总体汇总肿瘤检出率为 66.2% [95% 置信区间 (CI) 56.1-75.8]。人乳头瘤病毒（HPV）阳性病例的肿瘤检出率（81.5%，95% CI 60.8-96.4）显着高于HPV阴性病例（2.3%，95% CI 0.00-45.7）。加权总体并发症率为 11.4% (95% CI 7.2-16.2)。根据 Clavien-Dindo 分类，大多数为 I 级或 II 级（80%）。这项荟萃分析表明，TORS 在定位 CUP 患者的原发肿瘤部位方面是安全有效的。虽然目前的数据支持在 HPV 阳性患者中使用 TORS，但需要大量 HPV 阴性病例来确定 TORS 的真正诊断效果，然后才能在该特定亚组中推断出任何有效结论。进一步的研究应侧重于高质量的前瞻性试验，并进行严格的方法学检查，以尽量减少异质性并进行更准确的统计分析。© 2024。外科肿瘤学会。

Head and neck carcinoma of unknown primary (CUP) represents a challenging diagnostic process when standard work-up fails to identify the primary tumour site. The aim of this systematic review and meta-analysis was to evaluate the diagnostic utility and complication profile of transoral robotic surgery (TORS) tongue base mucosectomy (TBM) in the management of CUP.An electronic database search was performed in the EMBASE, MEDLINE, PubMed and Cochrane databases. A meta-analysis of proportions was performed to obtain an estimate of the overall proportion for the detection and complication rates.Nine studies representing 235 patients with CUP who had TORS TBM were included in the final analysis. The overall pooled tumour detection rate was 66.2% [95% confidence interval (CI) 56.1-75.8]. The incidence of tumour detection in human papilloma virus (HPV)-positive cases (81.5%, 95% CI 60.8-96.4) was significantly higher than HPV-negative cases (2.3%, 95% CI 0.00-45.7). Weighted overall complication rate was 11.4% (95% CI 7.2-16.2). The majority were grade I or II (80%) according to the Clavien-Dindo classification.This meta-analysis suggests TORS to be safe and effective in localising the primary tumour site in patients with CUP. While the current data supports the use of TORS in patients who are HPV positive, larger numbers of HPV-negative cases are required to determine the true diagnostic effect with TORS before any valid conclusions can be inferred in this particular subgroup. Further research should focus on high quality prospective trials with stringent methodological work-up to minimise heterogeneity and allow for more accurate statistical analysis.© 2024. Society of Surgical Oncology.