Endoscopic mucosal resection and endoscopic submucosal dissection for en bloc resection of superficial pharyngeal carcinomas

Background and study aim: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are being used increasingly to treat superficial oropharyngeal and hypopharyngeal carcinomas. The aim of this study was to clarify whether ESD provided better results than EMR for en bloc and complete resection of superficial pharyngeal carcinomas.

Patients and methods: A total of 76 superficial pharyngeal carcinomas in 59 consecutively treated patients were included. Patients underwent either conventional EMR (using a transparent cap or strip biopsy) (n = 45 lesions) or ESD (n = 31 lesions) between October 2006 and January 2011. The rates of en bloc resection, complete resection (defined as en bloc resection with tumor-free margins), major complications, and local recurrence were evaluated retrospectively as the therapeutic outcomes.

Results: ESD yielded significantly higher rates of both en bloc and complete resection compared with EMR (en bloc 77.4 % [24/31] vs. 37.8 % [17/45], P = 0.0002; complete 54.8 % [17/31] vs. 28.9 % [13/45], P = 0.0379). ESD was more frequently complicated by severe laryngeal edema (4/21 [19.0 %] vs. 1/31 [3.2 %], P = 0.1446) and was also more time-consuming (124.9 ± 65.1 minutes vs. 57.2 ± 69.6 minutes; P = 0.0014). Local recurrence was observed more often after EMR than after ESD (3/45 [6.7 %] vs. 0/31 [0 %]), although this difference did not reach statistical significance (P = 0.2658).

Conclusions: ESD appears to be a superior method of endoscopic resection of superficial pharyngeal carcinomas for achieving both en bloc and complete resection, although these benefits were also associated with a higher incidence of complications and a significantly longer procedure time. Large prospective studies are needed to compare ESD with conventional EMR for superficial pharyngeal carcinomas.

• References

• 1 Erkal HS, Mendenhall WM, Amdur RJ 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 Muto M, Minashi K, Yano T et al. Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: a multicenter randomized controlled trial. J Clin Oncol 2010; 28: 1566-1572
• 4 Muto M, Hironaka S, Nakane M et al. Association of multiple Lugol-voiding lesions with synchronous and metachronous esophageal squamous cell carcinoma in patients with head and neck cancer. Gastrointest Endosc 2002; 56: 517-521
• 5 Nonaka S, Saito Y. Endoscopic diagnosis of pharyngeal carcinoma by NBI. Endoscopy 2008; 40: 347-351
• 6 Kraus DH, Zelefsky MJ, Brock HA et al. Combined surgery and radiation therapy for squamous cell carcinoma of the hypopharynx. Otolaryngol Head Neck Surg 1997; 116: 637-641
• 7 Johansen LV, Grau C, Overgaard J. Hypopharyngeal squamous cell carcinoma – treatment results in 138 consecutively admitted patients. Acta Oncol 2000; 39: 529-536
• 8 Eckel HE, Staar S, Volling P et al. Surgical treatment for hypopharynx carcinoma: feasibility, mortality, and results. Otolaryngol Head Neck Surg 2001; 124: 561-569
• 9 Fang FM, Tsai WL, Chien CY et al. Changing quality of life in patients with advanced head and neck cancer after primary radiotherapy or chemoradiation. Oncology 2005; 68: 405-413
• 10 Muto M, Satake H, Yano T et al. Long-term outcome of transoral organ-preserving pharyngeal endoscopic resection for superficial pharyngeal cancer. Gastrointest Endosc 2011; 74: 477-484
• 11 Suzuki H, Saito Y, Oda I et al. Feasibility of endoscopic mucosal resection for superficial pharyngeal cancer: a minimally invasive treatment. Endoscopy 2010; 42: 1-7
• 12 Shimizu Y, Yamamoto J, Kato M et al. Endoscopic submucosal dissection for treatment of early stage hypopharyngeal carcinoma. Gastrointest Endosc 2006; 64: 255-259 discussion 260-252
• 13 Iizuka H, Okamura S, Onozato Y et al. Endoscopic submucosal dissection for colorectal tumors. Gastroenterol Clin Biol 2009; 33: 1004-1011
• 14 Oda I, Saito D, Tada M et al. A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 2006; 9: 262-270
• 15 Oka S, Tanaka S, Kaneko I et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 2006; 64: 877-883
• 16 Esaki M, Matsumoto T, Hirakawa K et al. Risk factors for local recurrence of superficial esophageal cancer after treatment by endoscopic mucosal resection. Endoscopy 2007; 39: 41-45
• 17 Ishihara R, Tanaka H, Iishi H et al. Long-term outcome of esophageal mucosal squamous cell carcinoma without lymphovascular involvement after endoscopic resection. Cancer 2008; 112: 2166-2172
• 18 Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
• 19 Oyama T, Tomori A, Hotta K et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 2005; 3: 67-70
• 20 Neuhaus H, Wirths K, Schenk M et al. Randomized controlled study of EMR versus endoscopic submucosal dissection with a water-jet hybrid-knife of esophageal lesions in a porcine model. Gastrointest Endosc 2009; 70: 112-120
• 21 Inoue H, Takeshita K, Hori H et al. Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 1993; 39: 58-62
• 22 Japan Society for Head and Neck Cancer. General rules for clinical studies on head and neck cancer. Tokyo: Kanehara; 2005
• 23 Inoue H, Endo M, Takeshita K et al. A new simplified technique of endoscopic esophageal mucosal resection using a cap-fitted panendoscope (EMRC). Surg Endosc 1992; 6: 264-265
• 24 Tada M, Shimada M, Murakami F et al. Development of strip-off biopsy [in Japanese with English abstract]. Gastroenterol Endosc 1984; 26: 833-839
• 25 Tada M. One piece resection and piece meal resection of early gastric cancer by strip biopsy [in Japanese with English abstract]. Igaku-Shoin 1998; 68-87
• 26 Japanese Society for Esophageal Disease. Guidelines for clinical and pathological studies on carcinoma of the esophagus. [in Japanese] 10th. edition Tokyo: Kanehara; 2007
• 27 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
• 28 Slaughter DP, Southwick HW, Smejkal W. Field cancerization in oral stratified squamous epithelium; clinical implications of multicentric origin. Cancer 1953; 6: 963-968