Predicting Cervical Lymph Node Metastasis Following Endoscopic Surgery in Superficial Head and Neck Carcinoma.

Ryuichi Okabe,Shuji Terai,Arata Horii,Yushi Ueki,Hiroshi Matsuyama,Takeshi Takahashi,Satoru Hashimoto,Ryusuke Shodo,Riuko Ohashi,Manabu Takeuchi,Keisuke Yamazaki,Yoichi Ajioka,Hajime Umezu

doi:10.3389/fsurg.2021.813260

Abstract

BackgroundEarly detection of head and neck carcinoma (HNC) as superficial HNC (SHNC) identified using recently developed optical techniques, such as magnifying endoscopy and narrow-band imaging (NBI), in combination with endoscopic surgeries enables minimally invasive treatment with favorable outcomes for HNC. This study aimed to identify the predictive factors for the rare but important clinical issue of SHNC, namely cervical lymph node metastasis (CLNM), following endoscopic resection.MethodsSixty-nine patients with SHNC who underwent endoscopic resection were enrolled in the study. Clinical data, preoperative endoscopic findings, pathological findings, and treatment outcomes were retrospectively reviewed. Because the pharyngeal mucosa lacks the muscularis mucosa, we measured tumor thickness in permanent pathology as an alternative to the depth of invasion. Correlations with the occurrence of CLNM were statistically examined.ResultsThe 5-year disease-specific survival rate was 100%. Of 69 patients, 3 (4.3%) developed CLNM. All had subepithelial but not epithelial tumors. The 0-IIa type in the macroscopic findings, type B2/B3 vessels in narrow-band imaging, tumors ≥ pathological stage T2, lymphatic invasion, positive surgical margins, and tumor thickness >1,000 μm showed significant correlations with CLNM following endoscopic resection. Furthermore, the classification of type B vessels was significantly associated with tumor thickness.ConclusionThe treatment outcomes following endoscopic resection for SHNC were favorable. The risk of CLNM following endoscopic resection in SHNC can be predicted by several preoperative endoscopic and postoperative pathological findings. Among them, the classification of type B vessels, which correlated with both tumor thickness and CLNM, might be a useful predictive factor.

Highlights

Head and neck carcinoma (HNC), laryngeal or pharyngeal carcinoma, is often found as an advancedstage disease [1]
Invasive interventions, including laryngectomy or concurrent chemoradiotherapy, are needed for curative therapy. This usually results in a swallowing disturbance or loss of voice, aggravating the quality of life [1]. Developed optical techniques such as narrow-band imaging (NBI) and magnifying endoscopy facilitate the detection of HNC at an early phase, i.e., superficial HNC (SHNC) [2]
SHNC is defined as cancer involving the epithelium/subepithelial layer but not the muscularis propria irrespective of the presence of cervical lymph node metastasis (CLNM) (Figure 1) [3,4,5]

Summary

Introduction

Head and neck carcinoma (HNC), laryngeal or pharyngeal carcinoma, is often found as an advancedstage disease [1]. Invasive transoral endoscopic resection such as endomucosal resection, endoscopic submucosal dissection, and endoscopic laryngopharyngeal surgery but not chemoradiotherapy or extensive surgery may be a suitable and sufficient treatment for SHNC as well as superficial esophageal squamous cell carcinoma. It achieves a favorable outcome and well-maintained postoperative functions [7]. Detection of head and neck carcinoma (HNC) as superficial HNC (SHNC) identified using recently developed optical techniques, such as magnifying endoscopy and narrow-band imaging (NBI), in combination with endoscopic surgeries enables minimally invasive treatment with favorable outcomes for HNC. This study aimed to identify the predictive factors for the rare but important clinical issue of SHNC, namely cervical lymph node metastasis (CLNM), following endoscopic resection

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