Su1481 Endoscopic Treatment for Superficial Carcinoma of Borderline Lesions Between the Cervical Esophagus and Hypopharynx

Abstract

Endoscopic Treatment for Superficial Carcinoma of Borderline Lesions Between the Cervical Esophagus and Hypopharynx Hirofumi Kawakubo*, Tai Omori, Rieko Nakamura, Kazuo Koyanagi, Hiroya Takeuchi, Yuko Kitagawa Surgery, Keio University School of Medicine, Tokyo, Japan; Surgery, Kawasaki Municipal Hospital, Kawasaki, Japan Background: Early diagnosis is the best ways to improve cancer patient prognoses. Also early treatment enables patients to keep quality of life because they can undergo minimal invasive treatment. However, the early detection of carcinoma in the borderline lesions between the cervical esophagus and hypopharynx is very difficult. Recent advance in upper GI endoscopy, such as high vision endscope, magnifying endoscope and NBI system have enabled us to find superficial carcinoma even in this lesions. We developed ELPS (endoscopic laryngo-pharyngeal surgery) as an endoscopic treatment for superficial laryngeal carcinoma and pharyngeal carcinoma. ELPS is transoral endoscopic surgery. Under general anesthesia, after lifting the larynx using the curved type laryngoscope, the endoscopist inserts endoscope and the operator inserts forceps and electric device transorally, and resects superficial phayngeal carcinoma. We define the superficial phayngeal carcinoma as a carcinoma which tdepth of tumor invasion is within the sub-epithelial layer. From January 2000 to April 2012, we have treated 267 lesions of the superficial carcinoma by ELPS. However, ELPS has not been applied for cervical esophagus carcinoma because of the narrow working space and interference of endoscopy, forceps and electric device. Therefore we developed a hybrid endoscopic surgery (ESD ELPS) for borderline lesions between the cervical esophagus and hypopharynx. The purpose of this study is to examine the usefulness and effectiveness of endoscopic treatment for superficial carcinoma of borderline lesions between cervical esophagus and hypopharynx. Methods: Hybrid endoscopic surgery (ESD and ELPS) was performed for 9 lesions, which involved both the hypopharynx and cervical esophagus during the period of January 2000 to November 2012. Among 9 patients, 5 are Cmen and 4 are women, mean age at first examination is 64.0 years (range 41-81). Average tumor size is 39.6 mm (11-80 mm) and average size of resected specimen is 53.3mm (22-85 mm) Results: Seven of nine patients had esophageal cancer treatments in their past histories, 2 for ESD, 3 for esophagectomy and 2 for chemoradiation. All lesions were completely resected. The complications of this procedure were laryngeal edema for 5 patients, which required overnight intubation for 3 patients and tracheostomy for 2 patients, and stricture of cervical esophagus for 3 patients, which required endoscopic dilation more than 10 times. There were no long-term complications in all patients. Conclusion: The results indicated the usefulness and effectiveness of hybrid endoscopic treatment (ELPS ESD) for superficial carcinoma of borderline lesion between the cervical esophagus and hypopharynx.