The short-term and long-term outcomes of the endoscopic resection for the superficial pharyngeal squamous cell carcinoma

Abstract

Background and study aims: Early detection of superficial pharyngeal squamous cell carcinoma (SPSCC) using narrow-band imaging as well as the increasing use of ER for gastrointestinal cancers may increase the number of ER for SPSCC. The aims of this study were to clarify the feasibility of ER for SPSCC and its long-term outcomes. Patients and methods: In total, 84 patients with 115 lesions were treated by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) between March 2004 and August 2012. We retrospectively assessed the en bloc and R0 resection rates, complications, lymph node metastasis (LNM), local recurrence, metachronous pharyngeal and esophageal SCC, 5-year overall and cause-specific survival rates. Results: Higher proportions of en bloc and R0 resection were achieved with ESD compared to EMR (en bloc 100 % vs. 60 %, P < 0.001; R0 59 % vs. 26 %, P < 0.005). There were no significant complications in both groups. None of the patients died from primary SPSCC during the median follow-up of 34 months (range, 3 – 115). LNM occurred in three patients and local recurrence was detected in seven patients (8.3 %) with eight lesions. Tumor thickness over 1000 μm (P < 0.005) and positive or inconclusive horizontal margins (P < 0.05) were significant risk factors for LNM and local recurrence, respectively. Twelve patients died because of co-existing clinical conditions. The 5-year overall and cause-specific survival rates were 80.7 % and 100 %, respectively. Conclusions: ER for SPSCC is a feasible treatment with promising results. Tumor thickness over 1000 μm is a significant risk factor for LNM and positive or inconclusive horizontal margin is a risk factor for local recurrence.

Efficacy of double‐scope endoscopic submucosal dissection and long‐term outcomes of endoscopic resection for superficial pharyngeal cancer

“…Consistent with previous studies, [16][17][18] CIS was not accompanied by LN metastasis. Because of few cases of metastasis, the risk factors for postoperative recurrent LN metastasis were not previously reported, with one exception: tumor thickness >1000 μm has been shown to be a risk factor for postoperative recurrent LN metastasis by both Kinjo et al 18 and our previous study. 19 We identified several additional risk factors for LN metastasis in the present study, including SEP invasion, lymphovascular invasion, and droplet infiltration.…”

“…19 We identified several additional risk factors for LN metastasis in the present study, including SEP invasion, lymphovascular invasion, and droplet infiltration. 17,18,20 Therefore, for LN metastasis, SEP invasion is necessary and tumor thickness >1000 μm is the greatest risk factor, followed by lymphovascular invasion. Combining our cases with previously reported cases of LN metastasis after ER, all 14 patients had lesions with SEP invasion; 43% (6/14) had lymphovascular invasion and 86% (12/14) had tumors with >1000 μm thickness.…”

“…Combining our cases with previously reported cases of LN metastasis after ER, all 14 patients had lesions with SEP invasion; 43% (6/14) had lymphovascular invasion and 86% (12/14) had tumors with >1000 μm thickness. 17,18,20 Therefore, for LN metastasis, SEP invasion is necessary and tumor thickness >1000 μm is the greatest risk factor, followed by lymphovascular invasion. We followed the same careful surveillance schedule for all patients in both the high-risk and low-risk groups, because metastatic risk analysis is not comprehensive enough as a result of limited experience.…”

Artificial intelligence‐based detection of pharyngeal cancer using convolutional neural networks

“…Increased attentiveness among endoscopists during observation of the pharynx and the development of an established screening routine for the pharynx have also helped in this regard. Enhanced detection of SPC occasionally enables treatment of SPC via endoscopic resection,5–7 endoscopic submucosal dissection (ESD), or endoscopic mucosal resection, which are established local resection techniques for superficial gastrointestinal cancers 8,9. We have reported favorable short‐term and long‐term treatment outcomes of ESD for SPC, which we think is important because ESD is a minimally invasive treatment technique that can preserve patients' functions, and consequently, their quality of life 10–12…”

Endoscopic submucosal dissection for superficial pharyngeal squamous cell carcinoma

“…The main disadvantage of these therapies was the loss of swallowing and speech functions, oral pain, dysfunction of the sense of taste, and also resulted in cosmetic deformities. 4,5 Endoscopic resection (ER) is a safe and minimally invasive treatment preserving the organ and the patient's quality of life, [6][7][8][9][10] but ER for SPSCC have not yet been reported in Taiwan. The indication for endoscopic resection and the pathologic criteria for curative resection is currently not clear.…”