Endoscopic submucosal dissection for treatment of mesopharyngeal and hypopharyngeal carcinomas.
OBJECTIVE
Application of the endoscopic submucosal dissection (ESD) technique, as well as elevation of the larynx in cooperation with an otolaryngologist, under general anesthesia has enabled en-block resection of early mesopharyngeal and hypopharyngeal carcinomas. The aim of this study was to retrospectively evaluate the safety of ESD and the efficacy of the elevation of the larynx for treatment of early mesopharyngeal and hypopharyngeal carcinomas.


METHODS
The study included 16 lesions in 13 patients who underwent ESD. To provide a sufficient working space, the larynx was elevated under direct laryngoscopy, and a tube was inserted and fixed onto the laryngeal side using the slot on the back of the laryngoscope.


RESULTS
The median maximum diameter of the lesions was 12.5 mm (range 2 - 37 mm). The en-block resection rate was 93.8 %. Lateral surgical margins in two patients were difficult to evaluate for technical reasons. The tube could not be removed from four patients on the day of the procedure due to laryngeal edema caused by the local injection. No serious complications were observed. Oral food intake was possible after a mean of 3.3 postoperative days.


CONCLUSIONS
With adequate intraoperative and postoperative management, ESD with elevation of the larynx may be very efficient and safe for endoscopic treatment of pharyngeal lesions.
Iizuka
T
T
Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan. t-iizuka@toranomon.gr.jp
Kikuchi
D
D
Hoteya
S
S
Yahagi
N
N
Takeda
H
H
D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004210:Dissection / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D020704:Laryngoscopes; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D020545:Respiratory Mucosa / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome