Kikuchi Daisuke, Suzuki Yugo, Yamashita Satoshi, Ochiai Yorinari, Hoteya Shu
Department of Gastroenterology Toranomon Hospital Kajigaya Kanagawa Japan.
Diagnostic and Therapeutic Gastrointestinal Endoscopy Clinic Kanagawa Japan.
DEN Open. 2025 Aug 11;6(1):e70180. doi: 10.1002/deo2.70180. eCollection 2026 Apr.
Traditionally, pharyngeal cancer was detected at an advanced stage, as examinations were usually performed only after symptoms such as pain or dysphagia appeared. Consequently, it was considered a malignancy with a poor prognosis. However, recent advances in image-enhanced endoscopy (IEE) have facilitated the early detection of superficial pharyngeal cancers. The combination of IEE and magnifying endoscopy enables both the detection and detailed characterization of lesions, including assessment of malignancy and invasion depth. Due to the anatomically complex structure of the pharyngolaryngeal region, en bloc resection using snare-based endoscopic mucosal resection has been difficult. However, the development of endoscopic submucosal dissection (ESD) and endoscopic laryngopharyngeal surgery has made en bloc resection technically possible. Successful pharyngeal ESD requires careful planning, including consideration of intubation route, laryngoscope positioning, and choice of devices. Tumor thickness ≥1000 µm and positive lymphovascular invasion are pathological risk factors for lymph node metastasis. However, no consensus exists regarding the need for additional adjuvant chemotherapy. After pharyngeal ESD, close follow-up is essential, focusing on lymph node metastasis and metachronous cancers. Lymph node metastasis may require dissection or radiotherapy, while metachronous lesions can often be treated endoscopically. A multidisciplinary approach is essential for effective management of superficial pharyngeal cancer.
传统上，下咽癌通常在晚期才被发现，因为检查通常仅在出现疼痛或吞咽困难等症状后才进行。因此，它被认为是一种预后较差的恶性肿瘤。然而，图像增强内镜检查（IEE）的最新进展促进了浅表下咽癌的早期检测。IEE与放大内镜检查相结合，能够检测病变并对其进行详细表征，包括评估恶性程度和浸润深度。由于咽喉区域的解剖结构复杂，使用圈套器进行内镜黏膜切除术整块切除一直很困难。然而，内镜黏膜下剥离术（ESD）和内镜下咽手术的发展使整块切除在技术上成为可能。成功的下咽ESD需要仔细规划，包括考虑插管途径、喉镜定位和器械选择。肿瘤厚度≥1000 µm和淋巴管侵犯阳性是淋巴结转移的病理危险因素。然而，对于是否需要额外的辅助化疗尚无共识。下咽ESD术后，密切随访至关重要，重点关注淋巴结转移和异时性癌。淋巴结转移可能需要进行清扫或放疗，而异时性病变通常可通过内镜治疗。多学科方法对于浅表下咽癌的有效管理至关重要。
