Efficacy and safety of the water pressure method for endoscopic submucosal dissection in superficial pharyngeal cancer

Abstract

Background: Superficial pharyngeal cancers can be cured with transoral surgery (TOS), which preserves organ function and quality of life. Pharyngeal endoscopic submucosal dissection (ESD) is challenging to perform because of limited manoeuvrability and complex anatomical features. The water pressure method (WPM) is useful for natural traction techniques during ESD, and is potentially useful for pharyngeal ESD. This study aimed to investigate the short-term outcomes of WPM-ESD for pharyngeal lesions. Patients and Methods: Therapeutic outcomes of patients who underwent WPM-ESD for pharyngeal lesions at Keio University between May 2019 and February 2022 were retrospectively analysed. Results: Twenty-one pharyngeal lesions treated with WPM-ESD were analysed. Three lesions were located in the oropharynx and 18 in the hypopharynx. All ESD procedures were performed under general anaesthesia. The endoscopic en bloc resection rate was 100%. The median procedure time was 15 min (range 4–45 min). All patients were successfully extubated on the day of ESD. No serious adverse events related to WPM-ESDs were observed. None of the patients required nasogastric intubation, percutaneous endoscopic gastrostomy, or tracheotomy. The median fasting time and hospital stay were 2 d (range 2–5 d) and 6 d (range 6–10 d), respectively. All the histological results indicated squamous cell carcinoma. The complete histologic resection rate was 76.2%. Conclusions: WPM-ESD achieved a high en bloc resection rate and short procedure time without serious adverse events. Thus, WPM-ESD may be a useful treatment for pharyngeal lesions.