Comparative study of treatment outcomes between ESD and TOVS (transoral videolaryngoscopic surgery)for superficial epithelial pharyngeal tumors

Aims Recently, endoscopic dissection (ESD) and transoral videolaryngoscopic surgery (TOVS) have become widely used as minimally invasive treatment for pharyngeal cancer in Japan. ESD in the pharynx is performed by a gastroenterologist under general anesthesia using a folding laryngoscope to expand the larynx. TOVS is a technique that has developed uniquely in Japan, in which an otolaryngologist performs tumor resection orally using a rigid endoscope,straight forceps and electrocautery.There have been no reports comparing the outcomes of ESD and TOVS. In this study, we compared the outcomes of patients who underwent ESD and those who underwent TOVS for superficial pharyngeal lesions.

Methods We reviewed 47 cases of superficial pharyngeal carcinoma treated with ESD or TOVS from 2013 to 2022 at our institution. We did not include cases treated with iatrogenic multiple treatments, recurrent treatments, or preoperative CRT.

Results There were 21 cases of ESD and 26 cases of TOVS. The median age was 68(61-72) years for ESD and 68(63-75) years for TOVS. The site of tumor was hypopharynx/oropharynx ESD: 30/15, TOVS: 15/11 (p=0.006), significantly more cases in the ESD group were in the hypopharynx. The median resection time was 71 (50-103.5) min for ESD and 82 (43.3-147.8) min for TOVS, and the depth of tumor was 6/15 (EP/SEP) for ESD and 12/14 (TOVS) for TOVS, and the median tumor diameter was 23 (15-36) mm for ESD and 16.5 (9-21.5) mm for TOVS. Tumor diameter was significantly larger in the ESD group. The positive rate of horizontal margin was 23.8% (5/21) for ESD and 53.8% (14/26) for TOVS. The R0 resection rate was 71.4% (15/21) for ESD and 38.5% (10/26) for TOVS, and the R0 resection rate was significantly higher for ESD. (p=0.024). (p=0.024)

Postoperative recurrence was 4.8% (1/21) for ESD and 26.9% (7/26) for TOVS. The 5year-cumulative recurrence rate was significantly higher in the TOVS than in the ESD (TOVS vs ESD=40.1% vs 10%, p=0.040). The 5year-disease specific survival(DSS) was not significantly different between TOVS and ESD.(TOVS vs ESD = 86.1% vs 100%, p=0.277)

Conclusions ESD has a higher R0 resection rate and fewer recurrences than TOVS in the treatment of superficial pharyngeal carcinoma.ESD seems to have a high R0 resection rate because of its reliable range diagnosis using endoscopic magnification and image enhancement.

Publication History

Article published online:
15 April 2024