Abstract:ELPS is a hybrid of head and neck surgery and gastrointestinal endoscopic treatment, and enjoys the merit of both procedures. ELPS makes it possible to perform minimally-invasive surgery, preserving both the swallowing and phonation functions.
“…Besides TLM and TORS, a few other transoral approaches using a flexible gastrointestinal endoscope for early HPC were also reported with favorable outcomes from Japan: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) performed by gastroenterologists [47–50] and endoscopic laryngopharyngeal surgery performed by otorhinolaryngologists and gastroenterologists [43]. However, indication for use of these methods was confined to only patients with superficial lesions in the pharynx without lymph node metastasis (N0), excluding patients with SGC, invasive cancer, or lymph node metastasis (≥N1).…”
Section: Discussionmentioning
confidence: 99%
“…For this purpose, laryngeal elevation using a curved rigid pharyngolaryngeal blade (Fig. 2a) (Nagashima Medical Instruments, Japan) is helpful in keeping the hypopharynx expanded, thus providing a favorable view of the entire pharyngolaryngeal lumen, although its benefit is limited to a flexible endoscope [43]. In this step, the exact resection line can be determined based on both the mucosal extent visualized by iodine staining and submucosal extent estimated by evaluating tumor mobility through direct palpation using forceps.Fig.…”
BackgroundTransoral videolaryngoscopic surgery (TOVS) was developed as a new distinct surgical procedure for hypopharyngeal cancer (HPC) and supraglottic cancer (SGC) staged at up to T3. However, long-term treatment outcomes of TOVS remain to be validated.MethodsUnder a straight broad intraluminal view provided by combined use of a distending laryngoscope and a videolaryngoscope, we performed en bloc tumor resection via direct bimanual handling of the ready-made straight-form surgical instruments and devices. We retrospectively analyzed functional and oncologic outcomes of 72 patients with HPC (n = 58) or SGC (n = 14) whose minimum follow-up was 24 months or until death.ResultsThe cohort comprised nine patients of Tis, 23 of T1, 33 of T2, and 7 of T3. Among 36 patients (50%) who underwent neck dissection simultaneously, all but one were pathologically node-positive. Twelve patients underwent postoperative concurrent chemoradiation (CCRT) as adjuvant treatment, and another four patients underwent radiation or CCRT for second or later primary cancer. The endotracheal tube was removed in an operation room in all but two patients who underwent temporary tracheostomy. Pharyngeal fistula was formed transiently in two patients. The median time until patients resumed oral intake and could take a soft meal was 2 and 5 days, respectively. Eventually, 69 patients (96%) took normal meals. The 5-year cause-specific survival (CSS), overall survival (OS), larynx-preserved CSS, and loco-regional controlled CSS were 87.3%, 77.9%, 86.0%, and 88.0%, respectively. Multivariate analysis revealed N2-3 as an independent prognostic factor in both CSS (hazard ratio [HR] = 25.51, P = 0.008) and OS (HR = 4.90, P = 0.022), which indirectly reflected higher risk of delayed distant metastasis.ConclusionsConsidering its sound functional and oncological outcomes with various practical advantages, TOVS can be a dependable, less invasive, and cost-effective surgical option of an organ-function preservation strategy for HPC and SGC.
“…Besides TLM and TORS, a few other transoral approaches using a flexible gastrointestinal endoscope for early HPC were also reported with favorable outcomes from Japan: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) performed by gastroenterologists [47–50] and endoscopic laryngopharyngeal surgery performed by otorhinolaryngologists and gastroenterologists [43]. However, indication for use of these methods was confined to only patients with superficial lesions in the pharynx without lymph node metastasis (N0), excluding patients with SGC, invasive cancer, or lymph node metastasis (≥N1).…”
Section: Discussionmentioning
confidence: 99%
“…For this purpose, laryngeal elevation using a curved rigid pharyngolaryngeal blade (Fig. 2a) (Nagashima Medical Instruments, Japan) is helpful in keeping the hypopharynx expanded, thus providing a favorable view of the entire pharyngolaryngeal lumen, although its benefit is limited to a flexible endoscope [43]. In this step, the exact resection line can be determined based on both the mucosal extent visualized by iodine staining and submucosal extent estimated by evaluating tumor mobility through direct palpation using forceps.Fig.…”
BackgroundTransoral videolaryngoscopic surgery (TOVS) was developed as a new distinct surgical procedure for hypopharyngeal cancer (HPC) and supraglottic cancer (SGC) staged at up to T3. However, long-term treatment outcomes of TOVS remain to be validated.MethodsUnder a straight broad intraluminal view provided by combined use of a distending laryngoscope and a videolaryngoscope, we performed en bloc tumor resection via direct bimanual handling of the ready-made straight-form surgical instruments and devices. We retrospectively analyzed functional and oncologic outcomes of 72 patients with HPC (n = 58) or SGC (n = 14) whose minimum follow-up was 24 months or until death.ResultsThe cohort comprised nine patients of Tis, 23 of T1, 33 of T2, and 7 of T3. Among 36 patients (50%) who underwent neck dissection simultaneously, all but one were pathologically node-positive. Twelve patients underwent postoperative concurrent chemoradiation (CCRT) as adjuvant treatment, and another four patients underwent radiation or CCRT for second or later primary cancer. The endotracheal tube was removed in an operation room in all but two patients who underwent temporary tracheostomy. Pharyngeal fistula was formed transiently in two patients. The median time until patients resumed oral intake and could take a soft meal was 2 and 5 days, respectively. Eventually, 69 patients (96%) took normal meals. The 5-year cause-specific survival (CSS), overall survival (OS), larynx-preserved CSS, and loco-regional controlled CSS were 87.3%, 77.9%, 86.0%, and 88.0%, respectively. Multivariate analysis revealed N2-3 as an independent prognostic factor in both CSS (hazard ratio [HR] = 25.51, P = 0.008) and OS (HR = 4.90, P = 0.022), which indirectly reflected higher risk of delayed distant metastasis.ConclusionsConsidering its sound functional and oncological outcomes with various practical advantages, TOVS can be a dependable, less invasive, and cost-effective surgical option of an organ-function preservation strategy for HPC and SGC.
“…In this case, we could easily perform surgery without any complications. Collaboration between a head and neck surgeon and a gastroenterologist on ELPS combined with ESD has been reported useful for treating even the hypopharyngeal lesions that have spread to the cervical esophagus which is difficult with TLM, TOVS, and TORS [19]. Although we do not have any robotic surgery systems in our institution, we were able to perform the treatment with human power alone.…”
Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here. Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection. Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection. Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction.
“…The recently developed narrow band imaging (NBI) technique is an innovative optical technology that can clearly distinguish the microvascular structure of organ surfaces. While NBI has been routinely used to diagnose superficial esophageal carcinomas [7], NBI with magnifying endoscopy was also shown to be a powerful and promising tool for identifying STPSCC during routine endoscopic examinations [8–11]. In fact, development of this tool led to an increase in the number of patients diagnosed with STPSCC.…”
Objectives. Superficial-type pharyngeal squamous cell carcinoma (STPSCC) is defined as carcinoma in situ or microinvasive squamous cell carcinoma without invasion to the muscular layer. An exploration of the biological characteristics of STPSCC could uncover the invasion mechanism of this carcinoma. Phosphatidylcholine (PC) in combination with fatty acids is considered to play an important role in cell motility. Imaging mass spectrometry (IMS) is especially suitable for phospholipid analysis because this technique can distinguish even fatty acid compositions. Study Design. IMS analysis of frozen human specimens. Methods. IMS analysis was conducted to elucidate the distribution of PC species in STPSCC tissues. STPSCC tissue sections from five patients were analyzed, and we identified the signals that showed significant increases in the subepithelial invasive region relative to the superficial region. Results. Three kinds of PC species containing arachidonic acid, that is, PC (16:0/20:4), PC (18:1/20:4), and PC (18:0/20:4), were increased in the subepithelial invasive region. Conclusion. These results may be associated with the invasion mechanism of hypopharyngeal carcinoma.
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