ENDOSCOPIC SUBEPITHELIAL DISSECTION FOR SUPERFICIAL PHARYNGEAL CANCER: A CASE SERIES OF 44 SUPERFICIAL CANCERS

Aims: The pharyngeal space is the entrance to any endoscopic examination of the upper gastrointestinal tract. Narrow band imaging (NBI) makes it possible to detect superficial cancers in this region. As a minimally invasive treatment, endoscopic subepithelial dissection (ESD) technique could be indicated. We investigated the feasibility and efficacy of ESD for superficial pharyngeal cancers and evaluated their clinical outcomes. Methods: Between October 2008 and December 2016, 44 superficial cancers were endoscopically removed from 32 consecutive patients (91% men, median age 70 years, range 58 – 83 years) under general anesthesia. Written informed consent was obtained from all patients. The endoscopic treatment involved both ESD, endoscopic mucosal resection (EMR) and endoscopic laryngeal-pharyngeal surgery (ELPS). ESD, EMR and ELPS were performed in collabolationcollaboration with ear, nose, and throat docthead and neck surgeoner. Results: Of the 32 patients, 8 (25%) had synchronous multiple cancers at pharyngeal mucosal sites. Eleven patients (34%) had a history of head and neck cancer, and 16 (50%) had a history of esophageal cancer. Of the 44 lesions, 23 were histologically diagnosed as Tis, 21 were as microinvasive squamouscell carcinoma. Forty-two lesions were located in the hypopharynx, and 4 were in the oropharynx. There were 1 severe adverse events: this case was developed severe spondylitis. The median fasting period was only 1 days (range 1 – 2 days) after treatment. With a median follow-up period of 34 months (range 11 – 120 months), the cause-specific survival rates at two years was 100%. All the patients could retain both the pharynx and the functions of speaking, breathing, and swallowing. Conclusions: ESD for superficial pharyngeal cancer is a feasible and effective method. Early detection makes it possible to perform a minimally invasive treatment, allowing excellent short-term survival and the retention of the organs and functions.