Department of Otorhinolaryngology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 252-0374, Japan.
Jpn J Clin Oncol. 2013 Aug;43(8):782-7. doi: 10.1093/jjco/hyt081. Epub 2013 Jun 7.
For years, it has been a major interest for surgeons and oncologists to develop a novel technique to detect hypopharyngeal cancers at an early stage and to treat the lesions in a less invasive manner. The advent of the narrow band imaging system combined endoscopy and various endoscopic approaches shed light on the new era of the minimum invasive management of superficial cancers in hypopharyngeal regions.
Three endoscopic approaches, endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic laryngopharyngeal surgery, were chronologically introduced at our institute. In this study, we focused on the clinical outcomes, advantages and limitations of each procedure.
A total of 30 patients (42 procedures) received transoral pharyngectomies between June 2006 and May 2012. Tracheotomy was performed in 9 of 42 (21%) patients. Three patients developed local recurrence and were subsequently controlled by additional transoral pharyngectomies. The 2- and 5-year local control rates were 92.8 and 83.5%. The 2- and 5-year overall survival rates were 82.1%.
Endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic laryngopharyngeal surgery-transoral pharyngectomies are useful procedures for treating superficial hypopharyngeal cancers. Endoscopic mucosal resection manifested the least invasiveness and may be beneficial for resecting small superficial lesions, endoscopic submucosal dissection may be advantageous for patients with difficult laryngopharyngeal exposure and endoscopic laryngopharyngeal surgery has shown the optimal effectiveness and minimal complications and can be applied to most of the hypopharyngeal sub-sites. All three procedures require a high level of technical skill and close collaboration between otolaryngologists and gastroenterologists.
多年来，外科医生和肿瘤学家一直致力于开发一种新的技术，以便在早期发现下咽癌，并以非侵入性方式治疗病变。窄带成像系统与内窥镜和各种内窥镜方法的出现，为下咽区域浅表性癌症的微创管理带来了新时代。
我们所在的机构先后引入了三种内窥镜方法，即内镜黏膜切除术、内镜黏膜下剥离术和内镜喉咽手术。本研究主要关注每种方法的临床结果、优势和局限性。
2006 年 6 月至 2012 年 5 月期间，共有 30 例（42 例手术）患者接受了经口咽切除术。42 例手术中有 9 例（21%）患者进行了气管切开术。3 例患者出现局部复发，随后通过额外的经口咽切除术得到控制。2 年和 5 年局部控制率分别为 92.8%和 83.5%。2 年和 5 年总生存率分别为 82.1%。
内镜黏膜切除术、内镜黏膜下剥离术和内镜喉咽手术-经口咽切除术是治疗下咽浅表性癌的有用方法。内镜黏膜切除术的侵袭性最小，可能有利于切除小的浅表性病变；内镜黏膜下剥离术可能有利于难以暴露的喉咽患者；内镜喉咽手术显示出最佳的疗效和最小的并发症，并且可以应用于大多数下咽亚部位。所有三种方法都需要耳鼻喉科医生和胃肠病学家之间的高度技术技能和密切协作。
