Endoscopy 2010; 42(1): 1-7
DOI: 10.1055/s-0029-1243807
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Feasibility of endoscopic mucosal resection for superficial pharyngeal cancer: a minimally invasive treatment

H.  Suzuki1 , Y.  Saito1 , I.  Oda1 , S.  Nonaka1 , Y.  Nakanishi2
  • 1Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
  • 2Pathology Division, National Cancer Center Research Institute, Tokyo, Japan
Weitere Informationen

Publikationsverlauf

submitted 2 June 2008

accepted after revision 21 August 2009

Publikationsdatum:
11. Januar 2010 (online)

Background and study aims: New diagnostic techniques have recently been developed so detection of superficial pharyngeal cancer is dramatically increasing and endoscopic mucosal resection (EMR) can now be performed on an experimental basis. The aim of this study was to clarify the effectiveness of EMR for superficial pharyngeal cancer.

Patients and methods: Between 2004 and 2007, 31 patients with 37 pharyngeal lesions underwent EMR at our hospital. EMR using a cap-fitted endoscope (EMR-C) was used on 34 lesions and strip biopsies on the remaining three. We retrospectively assessed the effectiveness of those procedures in treating superficial pharyngeal cancer.

Results: Median procedure time was 45 minutes (range 20 – 180 minutes) and median hospital stay was 7 days (range 4 – 12 days). Regarding complications, one patient experienced laryngeal edema, one suffered aspiration pneumonia, and two sustained dermatitis around the mouth caused by Lugol staining. Histologically, 18 lesions were confirmed as carcinoma in situ and the other 19 lesions demonstrated microinvasion of the subepithelial tissue with lymphatic invasion in one case. During the median follow-up period of 40 months (range 21 – 62 months), two patients received radiotherapy and two patients underwent an additional EMR because of recurrent tumors. Five other patients developed metachronous superficial pharyngeal cancers, but all those lesions were resected primarily by EMR while two of the study’s 31 patients died from esophageal cancer. None of the remaining 20 patients experienced any recurrent or metachronous tumors during their follow-up periods.

Conclusions: Our results indicated that EMR was a safe, effective, and minimally invasive treatment for superficial pharyngeal cancer.

References

  • 1 Erkal H S, Mendenhall W M, Amdur R J. et al . Synchronous and metachronous squamous cell carcinomas of the head and neck mucosal sites.  J Clin Oncol. 2001;  19 1358-1362
  • 2 Muto M, Nakane M, Katada C. et al . Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites.  Cancer. 2004;  101 1375-1381
  • 3 Sugimachi K, Ohno S, Matsuda H. et al . Lugol-combined endoscopic detection of minute malignant lesions of the thoracic esophagus.  Ann Surg. 1988;  208 179-183
  • 4 Yokoyama A, Ohmori T, Makuuchi H. et al . Successful screening for early esophageal cancer in alcoholics using endoscopy and mucosa iodine staining.  Cancer. 1995;  76 928-934
  • 5 Dawsey S M, Fleischer D E, Wang G Q. et al . Mucosal iodine staining improves endoscopic visualization of squamous dysplasia and squamous cell carcinoma of the esophagus.  Cancer. 1998;  83 220-231
  • 6 Kraus D H, Zelefsky M J, Brock H A. et al . Combined surgery and radiation therapy for squamous cell carcinoma of the hypopharynx.  Otolaryngol Head Neck Surg. 1997;  116 637-641
  • 7 Wahlberg P C, Andersson K E, Biorklund A T. et al . Carcinoma of the hypopharynx: analysis of incidence and survival in Sweden over a 30-year period.  Head Neck. 1998;  20 714-719
  • 8 Johansen L V, Grau C, Overgaard J. Hypopharyngeal squamous cell carcinoma-treatment results in 138 consecutively admitted patients.  Acta Oncol. 2000;  39 529-536
  • 9 Eckel H E, Staar S, Volling P. et al . Surgical treatment for hypopharynx carcinoma: feasibility, mortality, and results.  Otolaryngol Head Neck Surg. 2001;  124 561-569
  • 10 Gono K, Yamazaki K, Doguchi N. et al . Endoscopic observation of tissue by narrow-band illumination.  Opt Rev. 2003;  10 211-215
  • 11 Yoshida T, Inoue H, Usui S. et al . Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions.  Gastrointest Endosc. 2004;  59 288-295
  • 12 Nonaka S, Saito Y. Endoscopic diagnosis of pharyngeal carcinoma by NBI.  Endoscopy. 2008;  40 347-351
  • 13 Ono H, Kondo H, Gotoda T. et al . Endoscopic mucosal resection for treatment of early gastric cancer.  Gut. 2001;  48 151-152
  • 14 Soetikno R, Kaltenbach T, Yeh R. et al . Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract.  J Clin Oncol. 2005;  23 4490-4498
  • 15 Inoue H, Endo M, Takeshita K. et al . A new simplified technique of endoscopic mucosal resection using a cap-fitted panendoscope (EMRC).  Surg Endosc. 1992;  6 264-265
  • 16 Inoue H, Tani M, Nagai K. et al . Treatment of esophageal and gastric tumors.  Endoscopy. 1999;  31 47-55
  • 17 Tada M, Shimada M, Murakami F. et al . Development of strip-off biopsy [in Japanese with English abstract].  Gastroenterol Endosc. 1984;  26 833-839
  • 18 Tada M. One piece resection and piecemeal resection of early gastric cancer by strip biopsy [in Japanese with English abstract]. Tokyo; Igaku-Shoin 1998: 68-87
  • 19 Nagai K, Kawada K, Nishikage T. et al . Endoscopic treatment for superficial hypopharyngeal carcinoma [in Japanese with English abstract].  Stomach Intest. 2003;  38 331-338
  • 20 Shimizu Y, Yamamoto J, Kato M. et al . Endoscopic submucosal dissection for treatment of early stage hypopharyngeal carcinoma.  Gastrointest Endosc. 2006;  64 225-229
  • 21 Shimizu Y, Yoshida T, Kato M. et al . Long-term outcome after endoscopic resection in patients with hypopharyngeal carcinoma invading the subepithelium: a case series.  Endoscopy. 2009;  41 374-376
  • 22 Iizuka T, Kikuchi D, Hoteya S. et al . Endoscopic submucosal dissection for treatment of mesopharyngeal and hypopharyngeal carcinomas.  Endoscopy. 2009;  41 113-117
  • 23 Japan Society for Head and Neck Cancer .General rules for clinical studies on head and neck cancer. Tokyo; Kanehara 2005
  • 24 Sørensen W T, Wagner N, Aarup A T. et al . Beneficial effect of low-dose peritonsillar injection of lidocaine-adrenaline before tonsillectomy. A placebo-controlled clinical trial.  Auris Nasus Larynx. 2003;  30 159-162
  • 25 Mcguirt W F, Matthews B, Koufman J A. Multiple simultaneous tumors in patients with head and neck cancer.  Cancer. 1982;  50 1195-1199
  • 26 Shaha A R, Hoover E L, Mitrani M. et al . Synchronicity, multicentricity, and metachronicity of head and neck cancer.  Head Neck Surg. 1988;  10 225-228
  • 27 Shiozaki H, Tahara H, Imamoto H. et al . Endoscopic screening of early esophageal cancer with the lugol dye method in patients with head and neck cancers.  Cancer. 1990;  66 2068-2071
  • 28 Kokawa A, Yamaguchi H, Tachimori Y. et al . Other primary cancers occurring after treatment of superficial esophageal cancer.  Br J Surg. 2001;  88 439-443

Y. SaitoMD PhD 

Endoscopy Division, National Cancer Center Hospital

5-1-1 Tsukiji, Chuo-ku
Tokyo 104-0045
Japan

Fax: +81-3-35423815

eMail: ytsaito@ncc.go.jp