Combined endoscopic submucosal dissection and endoscopic laryngopharyngeal surgery for an oropharyngeal lesion extending to the flap of a glossopharyngeal reconstruction

Pharyngeal endoscopic submucosal dissection (ESD) [1] and endoscopic laryngopharyngeal surgery (ELPS) [2] [3] are reportedly effective treatments for superficial pharyngeal cancer (SPC). ESD allows the clinician to perform highly precise procedures involving large treatable areas owing to endoscopic manipulation. Although the treatable area of ELPS is limited by the mobility of the transoral devices, the operator can independently control the traction during dissection, resulting in efficient procedures [3]. Considering these characteristics, we present a case of SPC extending to the reconstructed flap that was resected using a combined ESD and ELPS procedure.

A 56-year-old man who had undergone total glossectomy and laryngectomy with glossopharyngeal reconstruction using the pectoralis major myocutaneous flap for oropharyngeal cancer 10 years previously underwent surveillance esophagogastroduodenoscopy. A 40-mm SPC was found on the posterior wall of the oropharynx extending to the reconstructed flap ([Fig. 1]). ESD and ELPS were therefore planned and performed ([Video 1]).

Fig. 1 Endoscopic images of the 40-mm lesion on the posterior wall of the oropharynx showing: a on distant view, the left wall to anterior wall of the oropharynx that was reconstructed using a left pectoralis major myocutaneous flap and the laryngoscope in position; b on close-up view, the part of the lesion that was extending to the flap (yellow arrowhead); c the appearance after marking had been performed using magnification with narrow-band imaging and iodine staining.

Combined endoscopic submucosal dissection and endoscopic laryngopharyngeal surgery are performed for an oropharyngeal lesion extending to the reconstructed flap.Video 1

We first made an incision and dissected from the oral side to the flap side using ESD with a DualKnife J (KD-655Q; Olympus, Tokyo, Japan) ([Fig. 2]), so that the edge of the specimen could be easily grasped with forceps. Performing ELPS with a Colorado MicroDissection Needle (E103; Stryker, Portage, Michigan, USA), we then performed a dissection focusing on the subcutaneous tissue layer, which contained a significant amount of fat. Afterward, we switched between ESD with/without traction [4] and ELPS as needed, achieving en bloc resection within 67 minutes, with no adverse events ([Fig. 3]). Histologic examination revealed a subepithelial invasive squamous cell carcinoma with negative margins.

Fig. 2 Endoscopic image during dissection of the flap, with a significant amount of fat visible within the subcutaneous tissue.

Fig. 3 Macroscopic appearance of the resected specimen, which was shown histologically to be a squamous cell carcinoma (0.7-mm thick) with negative margins.

Although there has been a previous case report of a lesion on the flap that was treated with ESD alone [5], resecting the layer of fat using only this technique is not efficient. We believe that the combination of ESD and ELPS is one option that could be used for the efficient treatment of lesions on the flap.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 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
• 2 Tateya I, Muto M, Morita S. et al. Endoscopic laryngo-pharyngeal surgery for superficial laryngo-pharyngeal cancer. Surg Endosc 2016; 30: 323-329
• 3 Yamaguchi H, Sato H, Tsukahara K. et al. Co-treatment with endoscopic laryngopharyngeal surgery and endoscopic submucosal dissection. Auris Nasus Larynx 2021; 48: 457-463
• 4 Matsuno K, Miyamoto H, Shono T. et al. Efficacy of a new traction method using ring-shaped thread for endoscopic submucosal dissection in the pharynx. Esophagus 2023; 20: 256-263
• 5 Kanesaka T, Matsuura N, Ishihara R. et al. Endoscopic resection of a squamous cell carcinoma on a pharyngeal flap. VideoGIE 2020; 5: 539-541

Publikationsverlauf

Artikel online veröffentlicht:
26. November 2024