Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan.
Auris Nasus Larynx. 2021 Jun;48(3):457-463. doi: 10.1016/j.anl.2020.10.003. Epub 2020 Oct 14.
Endoscopic laryngopharyngeal surgery (ELPS) is an effective and minimally invasive treatment for pharyngeal cancers. However, the disadvantages of ELPS are the interference of instruments in the operative field and the difficulty in approaching certain areas. To overcome these drawbacks, we began to perform combination treatment of ELPS and endoscopic submucosal dissection (ESD). The aim of the present study was to compare the efficacies of treatment with ELPS alone and ELPS combined with ESD.
A total of 103 lesions in 73 patients who underwent pharyngeal ELPS for superficial pharyngeal cancer between August 2014 and January 2020 at our hospital were analyzed. Lesions were divided into the ELPS alone group and ELPS combined with ESD group. Lesion characteristics, technical results, adverse events, and long-term outcomes were analyzed.
In the ELPS combined with ESD group, procedure speed was shorter than the ELPS alone group (20.2 ± 10.0 mm/min vs 13.0 ± 6.6 mm/min, p < 0.001), and R0 resection rate was higher (67.4% vs 45.6%, p = 0.027). There were no significant differences in tumor size, depth of tumor invasion, and adverse events among the 2 groups. These results remained unchanged after propensity score matching. The overall and cause-specific survival rates at 3 years were 96.7% and 100% for the ELPS combined with ESD group and ELPS alone group, respectively.
Combination treatment of ESD and ELPS enabled more efficient resection than ELPS alone. Cooperative treatment of pharyngeal cancer patients involving gastroenterologists and head and neck surgeons is effective and beneficial, and results in favorable long-term outcomes.
内镜下咽及喉切除术（ELPS）是治疗咽癌的一种有效、微创的方法。然而，ELPS 的缺点是手术野中器械的干扰以及某些区域难以接近。为了克服这些缺点，我们开始进行 ELPS 和内镜黏膜下剥离术（ESD）的联合治疗。本研究旨在比较单独行 ELPS 与 ELPS 联合 ESD 治疗的疗效。
分析了 2014 年 8 月至 2020 年 1 月我院收治的 73 例因早期下咽癌接受咽 ELPS 治疗的患者的 103 处病变。病变分为单独 ELPS 组和 ELPS 联合 ESD 组。分析病变特征、技术结果、不良事件和长期结果。
在 ELPS 联合 ESD 组中，手术速度快于单独 ELPS 组（20.2±10.0mm/min 比 13.0±6.6mm/min，p<0.001），R0 切除率更高（67.4%比 45.6%，p=0.027）。两组肿瘤大小、肿瘤浸润深度和不良事件无显著差异。倾向评分匹配后结果仍不变。ELPS 联合 ESD 组和单独 ELPS 组的 3 年总生存率和病因特异性生存率分别为 96.7%和 100%。
ESD 联合 ELPS 的联合治疗比单独 ELPS 更能有效地进行切除。胃肠病学家和头颈外科医生联合治疗咽癌患者是有效和有益的，可获得良好的长期结果。
