Degree of pharyngeal deformation caused by pharyngeal endoscopic submucosal dissection is associated with the incidence of aspiration pneumonia

Abstract

Background and study aims Endoscopic submucosal dissection (ESD) is one of the most minimally invasive treatments for superficial squamous cell cancer of the pharynx. However, aspiration pneumonia (AsP) associated with postoperative deformity of the pharynx may occur. The purpose of this study was to investigate the frequency of AsP and the degree of pharyngeal deformity after pharyngeal ESD.

Patients and methods This was a retrospective observational study of patients who underwent pharyngeal ESD at Okayama University Hospital between 2006 and 2017. The degree of pharyngeal deformation was assessed using the pharyngeal deformation grade (PDG). The primary endpoint was the frequency of AsP as a long-term adverse event.

Results Among the 52 patients enrolled, nine developed aspiration pneumonia, with a 3-year cumulative incidence of 9.0 % (95 % confidence interval [CI], 3.3 %–22.0 %). There were 16, 18, 16, and two patients that had PDG 0, 1, 2, and 3, respectively. Patients with a history of radiotherapy, as a treatment of head and neck cancer (44.4 % vs. 11.6 %; P = 0.02) and the high PDG group (PDG 2 and 3) (77.8 % vs. 25.6 %; P = 0.005) had a significantly higher incidence of AsP. The 3-year cumulative incidence rate of AsP after ESD in the high PDG group was significantly higher than that in the low PDG group (PDG 0 and 1) (23.9 % [95 %CI, 9.2.–49.5%] vs. 0 %; P = 0.03).

Conclusions The incidence of aspiration pneumonia in the long-term course after pharyngeal ESD was revealed. The incidence of aspiration pneumonia may be associated with pharyngeal deformity, but further studies are needed.

• References

• 1 Abe M, Iwamuro M, Kawahara Y. et al. Clinicopathological features and outcomes of endoscopic submucosal dissection for superficial cancer of the pharynx. Acta Med Okayama 2019; 73: 109-115
• 2 Hanaoka N, Ishihara R, Takeuchi Y. et al. Endoscopic submucosal dissection as minimally invasive treatment for superficial pharyngeal cancer: a phase II study (with video). Gastrointest Endosc 2015; 82: 1002-1008
• 3 Iizuka T, Kikuchi D, Suzuki Y. et al. Clinical relevance of endoscopic treatment for superficial pharyngeal cancer: feasibility of techniques corresponding to each location and long-term outcomes. Gastrointest Endosc 2021; 93: 818-827
• 4 Muto M, Satake H, Yano T. et al. Long-term outcome of transoral organ-preserving pharyngeal endoscopic resection for superficial pharyngeal cancer. Gastrointest Endosc 2011; 74: 477-484
• 5 Imanishi Y, Ozawa H, Sakamoto K. et al. Clinical outcomes of transoral videolaryngoscopic surgery for hypopharyngeal and supraglottic cancer. BMC Cancer 2017; 17: 445
• 6 Tateya I, Muto M, Morita S. et al. Endoscopic laryngo-pharyngeal surgery for superficial laryngo-pharyngeal cancer. Surg Endosc 2016; 30: 323-329
• 7 Kinjo Y, Nonaka S, Oda I. et al. The short-term and long-term outcomes of the endoscopic resection for the superficial pharyngeal squamous cell carcinoma. Endosc Int Open 2015; 3: E266-E273
• 8 Tomifuji M, Araki K, Yamashita T. et al. Transoral videolaryngoscopic surgery for oropharyngeal, hypopharyngeal, and supraglottic cancer. Eur Arch Otorhinolaryngol 2014; 271: 589-597
• 9 Iizuka T, Kikuchi D, Hoteya S. et al. Clinical advantage of endoscopic submucosal dissection over endoscopic mucosal resection for early mesopharyngeal and hypopharyngeal cancers. Endoscopy 2011; 43: 839-843
• 10 Tomifuji M, Araki K, Yamashita T. et al. Risk factors for dysphagia after transoral videolaryngoscopic surgery for laryngeal and pharyngeal cancer. Head Neck 2016; 38: 196-201
• 11 Okami K, Ebisumoto K, Sakai A. et al. Transoral en bloc resection of superficial laryngeal and pharyngeal cancers. Head Neck 2013; 35: 1162-1167
• 12 Logemann JA. Behavioral management for oropharyngeal dysphagia. Folia Phoniatr Logop 1999; 51: 199-212
• 13 Logemann JA. The role of exercise programs for dysphagia patients. Dysphagia 2005; 20: 139-140
• 14 Carnaby-Mann G, Crary MA, Schmalfuss I. et al. “Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Physics 2012; 83: 210-219
• 15 Sato Y, Araki Y, Tominaga T. et al. Endoscopic layngo pharyngeal surgery (ELPS) Prevention of surgical complications. Covering mucosal defects with fibrin glue and polyglycolic acid sheet (MCFP technique) and ELPS training. . Japan J Head Neck Cancer 2009; 37: 514-519
• 16 Mukai M, Eguchi K, Shirakura S. et al. Staged resection and local intralesional triamcinolone acetonide injection to prevent postoperative stricture for multiple superficial hypopharyngeal cancer a case report. J Japan Society Head Neck Surgery 2019; 29: 349-354
• 17 Watanabe Y, Imanishi Y, Ozawa H. et al. Prevention of pharyngeal stenosis by local injection of triamcinolone acetonide after transoral surgery for pharyngolaryngeal cancer. J Japan Society Head Neck Surgery 2018; 28: 107-113
• 18 Watanabe Y, Tanaka S, Hiratsuka Y. et al. Defect repair with fibrin glue/polyglycolic acid after endoscopic laryngopharyngeal cancer resection. Laryngoscope 2020; 130: 1740-1745
• 19 Wall LR, Ward EC, Cartmill B. et al. Physiological changes to the swallowing mechanism following (chemo)radiotherapy for head and neck cancer: a systematic review. Dysphagia 2013; 28: 481-493
• 20 Chiu YH, Tseng WH, Ko JY. et al. Radiation-induced swallowing dysfunction in patients with head and neck cancer: A literature review. J Formos Med Assoc 2022; 121: 3-13
• 21 Shirasu H, Yokota T, Hamauchi S. et al. Risk factors for aspiration pneumonia during concurrent chemoradiotherapy or bio-radiotherapy for head and neck cancer. BMC Cancer 2020; 20: 182