Endoscopic Laryngopharyngeal Surgery Research Articles

Evaluation of synchronous multiple primary superficial laryngo-pharyngeal cancers that were treated by endoscopic laryngo-pharyngeal surgery

Evaluation of synchronous multiple primary superficial laryngo-pharyngeal cancers that were treated by endoscopic laryngo-pharyngeal surgery

Effective traction using a clip with rubber band and grasping forceps in endoscopic laryngopharyngeal surgery.

The number of detected pharyngeal tumors has been increasing. Endoscopic laryngopharyngeal surgery (ELPS) is often performed for these tumors and can be an effective method of preserving speech and swallowing functions. ELPS is also useful for superficial pharyngeal tumors [1] [2]. Conventionally, laryngeal forceps are used to directly grasp and retract the lesion; however, only limited endoscope maneuvering is possible owing to interference between the laryngeal forceps and the endoscope ([Fig. 1]) [3]. To avoid this interference, we customized a clip (ZEOCLIP; Zeon Medical Inc., Tokyo, Japan) by attaching a rubber band ([Fig. 2]). This clip has mainly been used for colorectal endoscopic submucosal dissection, and there are some reports confirming its effectiveness [4] [5]; however, there are no reports about its effectiveness in ELPS. Herein, we report our experience performing ELPS using this customized clip ([Video 1]).

A prospective evaluation of postoperative swallowing function and dysphagia following endoscopic laryngopharyngeal surgery.

Endoscopic laryngopharyngeal surgery (ELPS) is a minimally invasive transoral surgery for superficial pharyngeal and laryngeal cancer, but dysphagia occasionally occurs post-treatment. We investigated dysphagia following ELPS and its risk factors. Of the 145 patients who underwent ELPS, 92 were evaluated in this study using the Hyodo score, Functional Outcome Swallowing Scale, Eating Assessment Tool-10 along with the total scores for the three items of the method of intake, time, and food preoperatively and on postoperative 1, 3, and 6months. We examined the 6-month trends of these values. Furthermore, the fasting period post-surgery, the need for swallowing rehabilitation by a speech therapist, and postoperative pneumonia episodes were set as outcomes reflecting the short-term swallowing function. We determined the associations between these outcomes and patient background factors. Postoperatively, the Hyodo score worsened at 1month but recovered at 3months. The Hyodo scores of all patients who underwent postcricoid ELPS did not worsen. The diameter of the resected specimen (DRS) was significantly associated with the need for swallowing rehabilitation and postoperative fasting time. A DRS ≥ 35mm was considered the threshold for the need of swallowing rehabilitation, postoperative pneumonia, and prolonged postoperative fasting time. ELPS exerts a temporal and limited impact on the swallowing function, which recovers within 3months in every swallowing evaluation. This necessitates additional care during the treatment of patients with mucosal defects ≥ 35mm, owing to the significant association between the DRS and short-term swallowing function.

化学療法後にELPSを施行し喉頭温存し得た下咽頭癌の2例

Endoscopic laryngopharyngeal surgery (ELPS) is a minimally invasive therapy, in which superficial lesions are resected directly with the assistance of a laryngoscope.

A case report of an alcoholic with delirium tremens diagnosed with hypopharyngeal cancer: Psychiatrists played important roles in the smooth diagnosis and treatments

AbstractBackgroundAlcohol use increases the risk of developing several types of cancer. Of these, hypopharyngeal cancer has one of the worst prognoses. Moreover, treating an alcoholic patient with hypopharyngeal cancer is often difficult. There are various treatments for hypopharyngeal cancer, including surgery, chemotherapy, and radiotherapy, depending on the state of the cancer and the patient's quality of life. Patients need physical, psychological, and social support in decision‐making and post‐treatment follow‐up. This is especially true for alcoholic patients.Case PresentationA 59‐year‐old man was admitted to our hospital with complaints of fatigue, loss of appetite, and tremor of the upper limbs. He was single, alcoholic, and had no family. After treatment for delirium tremens, he complained of throat pain. After endoscopy, magnetic resonance imaging, and examination with 18F‐fluorodeoxyglucose positron emission tomography/computed tomography, he was diagnosed with Stage 4 A (T2 N2c M0) hypopharyngeal cancer. The psychiatrist and otolaryngologist discussed the patient's decision‐making capacity and the various risks associated with treatment. Shared decision‐making with the patient was considered most important in determining the treatment strategy. As a result, the patient decided to receive endoscopic laryngopharyngeal surgery in combination with lymphadenectomy, a challenging surgical treatment. The operation was successful, and the patient is now ready for a new life after discharge.ConclusionPsychiatrists have a significant role to play in the oncological treatment of patients with alcoholism and other psychiatric disorders.

Two Cases of Basaloid Squamous Cell Carcinoma of the Hypopharynx Treated Using Endoscopic Laryngopharyngeal Surgery

Two Cases of Basaloid Squamous Cell Carcinoma of the Hypopharynx Treated Using Endoscopic Laryngopharyngeal Surgery

Larynx-preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery for hypopharyngeal basaloid squamous cell carcinoma invading cervial esophagus

Larynx-preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery for hypopharyngeal basaloid squamous cell carcinoma invading cervial esophagus

Current Status of Transoral Surgery for Patients With Early-Stage Pharyngeal and Laryngeal Cancers in Japan.

As the laryngopharynx is closely related to swallowing, speech, and phonation, it is necessary to consider not only disease control but also a minimally invasive approach for the treatment of laryngopharyngeal cancer. Transoral surgery has been reported to be a minimally invasive method for treating these diseases. Transoral videolaryngoscopic surgery (TOVS) and endoscopic laryngo-pharyngeal surgery (ELPS) have been developed in Japan and recently emerged as treatments for patients with early stage pharyngeal and laryngeal cancers. However, securing an appropriate field of view and a narrow operating space during TOVS or ELPS are critical issues to be resolved for these surgeries. The clinical significance and safety of transoral robotic surgery (TORS) using the da Vinci Surgical System have been widely reported to provide surgeons with increased visualization and magnification, resulting in precise surgical margins and rapid functional recovery. In this context, a multi-institutional clinical study was conducted to evaluate the treatment outcomes of TORS for the treatment of laryngopharyngeal cancer in Japan, and the da Vinci Surgical System for oral robot-assisted surgery for these diseases was approved by the Pharmaceutical Affairs Agency in August 2018. This review provides an overview of the therapeutic effects of TOVS, ELPS, and TORS, with a particular focus on these therapeutic results in Japan.

Clinical impact of gastrointestinal endoscopy on the early detection of pharyngeal squamous cell carcinoma: A retrospective cohort study.

BACKGROUNDIn recent years, with the growing availability of image-enhanced gastrointestinal endoscopy, gastroenterologists have contributed to the early detection of pharyngeal squamous cell carcinomas (SCC).AIMTo clarify the clinical characteristics of pharyngeal SCCs detected by gastrointestinal endoscopy.METHODSThis is a retrospective cohort study conducted in a single-center, a university hospital in Japan. We retrospectively assessed the clinical records of 522 consecutive patients with oropharyngeal or hypopharyngeal SCC who were examined in our hospital between 2011 and 2018. The lesions were classified into two groups: Group GE (detected by gastrointestinal endoscopy) and Group non-GE (detected by means other than gastrointestinal endoscopy). The clinical characteristics were compared between the two groups. Continuous data were compared using the Mann–Whitney U test. Pearson’s χ2 test or Fisher's exact test was used to analyze the categorical data and compare proportions. The Kaplan–Meier method was used to estimate the cumulative patient survival rates.RESULTSIn our study group, the median age was 65 years and 474 patients (90.8%) were male. One hundred and ninety-six cases (37.5%) involved the oropharynx and 326 cases (62.5%) involved the hypopharynx. Three hundred and ninety-five cases (75.7%) had some symptoms at the time of diagnosis. One hundred and forty-five (27.8%) cases had concurrent ESCC or a history of ESCC. One hundred and sixty-four (31.4%) cases were detected by gastrointestinal endoscopy and classified as Group GE. The proportions of asymptomatic cases, cTis-1 cases and cases with no lymph node metastasis were significantly higher in Group GE than Group non-GE (61.6% vs 7.3%, P < 0.001, 32.9% vs 12.0%, P < 0.001 and 69.5% vs 19.0%, P < 0.001). Endoscopic laryngo-pharyngeal surgery or endoscopic submucosal dissection were performed in only 0.6% of the lesions in Group non-GE but in 21.3% of the lesions in Group GE (P < 0.001). Overall survival was significantly longer in Group GE than in Group non-GE (P = 0.018). The 2-year and 4-year survival rates were 82.5% and 70.7% in Group GE, and 71.5% and 59.0% in Group non-GE, respectively.CONCLUSIONGastrointestinal endoscopy plays an important role in the early detection and improving the prognosis of pharyngeal SCCs.

Evaluation of synchronous multiple primary superficial laryngo-pharyngeal cancers that were treated by endoscopic laryngo-pharyngeal surgery

Objectivendoscopic laryngopharyngeal surgery (ELPS) is a useful surgery for superficial cancers of the head and neck region, but it has not yet been well evaluated for synchronous multiple primary cancers (multiple primaries). The purpose of this study was to clarify the safety and usefulness of ELPS for patients with multiple superficial primary cancers in the head and neck region. Methodsrom December 2009 to December 2016, 145patients with superficial head and neck cancers underwent ELPS. The patients were divided into two groups; a group consisting of patients with a single primary cancer (single primary) and another group consisting of patients with synchronous multiple primaries, and the incidences of postoperative complications and lymph node metastasis were retrospectively compared between the two groups. Resultsf the 145 patients, 107 had a single primary cancer and 38 had multiple primaries. There was no significant difference in the age, sex, or rate of intraepithelial cancer between the two groups. Postoperative complications included dysphagia in 6 (5.6%) patients with a single primary and 2 (5.3%) patients with multiple primaries. One patient with multiple primaries required gastrostomy because of aspiration pneumonia. In addition, the following complications were also observed. Laryngeal paralysis occurred in 2 (1.9%) patients with a single primary, and 1 (2.6%) patient with multiple primaries; tracheostomy because of postoperative bleeding in 1 (0.9%) patient with a single primary; infection occurred in 2 (5.3%) patients with multiple primaries. Postoperative lymph node metastasis was found in 7 (6.5%) patients with a single primary and 6 (15.8%) patients with multiple primaries. Lymphatic invasion of the primary cancer was noted in 3 (2.8%) patients with a single primary and 5 (13.2%) patients with multiple primaries, being significantly higher in the latter group. ConclusionELPS is also a safe surgery for patients with multiple primaries. However, the incidence of lymphatic invasion of the primary cancer was significantly higher in patients with multiple primaries.

Treatment outcomes of transoral robotic and non-robotic surgeries to treat oropharyngeal, hypopharyngeal, and supraglottic squamous cell carcinoma: A multi-center retrospective observational study in Japan

ObjectivesThe aim of this multicenter retrospective cohort study was to compare efficacy and subsequent postoperative treatment between transoral robotic surgery (TORS) and any non-robotic transoral surgery in Japanese patients with early oropharyngeal squamous cell carcinoma (OPSCC), hypopharyngeal SCC (HPSCC), or supraglottic SCC (SGSCC). Materials and methodsClinical information and surgical outcomes were compared between patients with early-stage OPSCC, HPSCC, and SGSCC who underwent TORS (TORS cohort) and those who underwent non-robotic transoral surgery, including transoral videolaryngoscopic surgery (TOVS), endoscopic laryngopharyngeal surgery (ELPS), and transoral laser microsurgery (TLM) (non-robotic cohort). The data of the Head and Neck Cancer Registry of Japan (registry cohort) were used to validate the comparison. The main outcomes were the presence of positive margins under pathology and the requirement for postoperative therapy, including radiotherapy or chemoradiotherapy. ResultsSixty-eight patients in the TORS cohort, 236 patients in the non-robotic cohort, and 1,228 patients in the registry cohort were eligible for this study. Patients in the TORS cohort were more likely to have oropharyngeal tumor disease and T2/3 disease than those in the other cohorts (P<0.001 and P=0.052, respectively). The TORS cohort had significantly fewer patients with positive surgical margins than the non-robotic cohort (P=0.018), as well as fewer patients who underwent postoperative treatment, although the difference was not significant (P=0.069). In the subgroup analysis of patients with OPSCC, a total of 57 patients in the TORS cohort, 73 in the non-robotic cohort, and 171 in the registry cohort were eligible for the present study. Patients with OPSCC who underwent TORS were more likely to have lateral wall lesions than those in the other cohorts (P=0.003). The TORS cohort also had significantly fewer patients with positive surgical margins than the non-robotic cohort (P=0.026), and no patients in the TORS cohort underwent any postoperative treatment for OPSCC, although the difference was not significant (P=0.177). ConclusionsOur results suggest that TORS leads to fewer positive surgical margins than non-robotic transoral surgeries. The clinical significance of TORS may be further validated through the results of all-case surveillance for patients who underwent TORS running in Japan in the future.

Pedunculated lipoma of the hypopharynx resected by endoscopic laryngo-pharyngeal surgery : A case report

Pedunculated lipoma of the hypopharynx resected by endoscopic laryngo-pharyngeal surgery : A case report

Co-treatment with endoscopic laryngopharyngeal surgery and endoscopic submucosal dissection

ObjectiveEndoscopic laryngopharyngeal surgery (ELPS) is an effective and minimally invasive treatment for pharyngeal cancers. However, the disadvantages of ELPS are the interference of instruments in the operative field and the difficulty in approaching certain areas. To overcome these drawbacks, we began to perform combination treatment of ELPS and endoscopic submucosal dissection (ESD). The aim of the present study was to compare the efficacies of treatment with ELPS alone and ELPS combined with ESD. MethodsA total of 103 lesions in 73 patients who underwent pharyngeal ELPS for superficial pharyngeal cancer between August 2014 and January 2020 at our hospital were analyzed. Lesions were divided into the ELPS alone group and ELPS combined with ESD group. Lesion characteristics, technical results, adverse events, and long-term outcomes were analyzed. ResultsIn the ELPS combined with ESD group, procedure speed was shorter than the ELPS alone group (20.2 ± 10.0 mm2/min vs 13.0 ± 6.6 mm2/min, p < 0.001), and R0 resection rate was higher (67.4% vs 45.6%, p = 0.027). There were no significant differences in tumor size, depth of tumor invasion, and adverse events among the 2 groups. These results remained unchanged after propensity score matching. The overall and cause-specific survival rates at 3 years were 96.7% and 100% for the ELPS combined with ESD group and ELPS alone group, respectively. ConclusionsCombination treatment of ESD and ELPS enabled more efficient resection than ELPS alone. Cooperative treatment of pharyngeal cancer patients involving gastroenterologists and head and neck surgeons is effective and beneficial, and results in favorable long-term outcomes.

Efficacy of polyglycolic acid sheets and fibrin glue for the prevention of post-ELPS bleeding

ObjectiveTo assess the efficacy and safety of a covering method using polyglycolic acid (PGA) sheets and fibrin glue in preventing laryngopharyngeal bleeding after endoscopic laryngopharyngeal surgery (ELPS) combined with endoscopic submucosal dissection (ESD). MethodsTwenty-one patients who underwent ELPS combined with ESD (28 resected pharyngeal carcinomas) were retrospectively evaluated. After completing ELPS combined with ESD, fibrinogen was sprayed onto the ulcer. A PGA sheet cut into 5 × 5 mm pieces that fit the size of the ELPS-induced ulcer was then placed over the ulcer and fixed in place with a fibrin glue comprising thrombin. ResultsThe resection procedure was performed for all lesions. The median long diameter of the resected specimen was 36 mm. The rate of a resected specimen diameter >30 mm, use of anticoagulant/platelet, and macroscopic classification 0-Ⅱa were 68% (19/28), 19% (5/28), and 36% (10/28), respectively. The median time required to cover ELPS-induced ulcers using PGA sheets and fibrin glue was 10 min (range: 3–22 min). No post-ELPS bleeding, subcutaneous emphysema, or aspiration pneumonia (0/28) was observed. ConclusionThe covering method using PGA sheets and fibrin glue for ELPS-induced ulcers is considered to be sufficiently safe and effective in preventing post-ELPS laryngopharyngeal bleeding. This method could be useful in preventing post-ELPS bleeding in patients with head and neck cancer.

Larynx-preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery for cervical esophageal cancer invading pharynx.

Larynx preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery (HELPS) was created for resectable cervical esophageal cancer (CEC) invading the hypopharynx. This study aimed to verify the effectiveness and to evaluate the feasibility of the new HELPS treatment method. Between 2014 and 2018, 19 patients with CEC invading the hypopharynx were treated with HELPS. The postoperative complications and survival rates were reviewed. Postoperative recurrent laryngeal nerve paralysis occurred in four patients. All patients consumed food orally without a feeding tube at the time of the discharge. The median follow-up period was 27months. The 2- and 3-year overall survival rates were 94.7 and 71.5%, respectively. HELPS, a new surgical treatment method that utilizes endoscopic surgery, is effective, feasible and beneficial for preserving the larynx in patients with CEC even if the tumor invaded the pharynx.

Endoscopic laryngopharyngeal surgery for hypopharyngeal lesions.

Transoral approaches for laryngeal/pharyngeal malignancies have been widely accepted as minimally invasive treatment options; however, hypopharyngeal lesions treated by transoral surgery have rarely been reported due to the difficulties in visualizing the hypopharynx. Since 2010, we have treated superficial hypopharyngeal lesions with endoscopic laryngopharyngeal surgery (ELPS), and herein report the outcomes of this transoral procedure. One hundred and eighteen patients with superficial hypopharyngeal lesions were treated by ELPS from February 2010 to February 2017, and the clinical courses of the patients were reviewed. Four females and 114 males (average: 65.6 y-o) were included in this study. Some patients had multiple lesions and a total of 154 superficial hypopharyngeal lesions (dysplasia: 29, Tis: 52, T1: 44, T2: 20, T3: 9) were treated with ELPS. Ten patients had only dysplasia and no carcinoma. Five patients presented with nodal metastases and 11 patients had simultaneous oropharyngeal lesions. In all cases, the hypopharynx was well visualized with sufficient working space, and no cases required a change in surgical approach. All post-operative complications were safely managed. In regard to the oncological outcomes, of the 108 patients with malignant lesions, the 3-year and 5-year overall survival (OS) rate was 93.6% and 85.5%, respectively. During ELPS, the hypopharynx was well visualized providing sufficient working space for the resection. The procedure was safe and feasible for superficial hypopharyngeal lesions and exhibited very good oncological outcomes. ELPS is thought to be a very effective surgical alternative for superficial hypopharyngeal lesions.

The investigation of salvage endoscopic laryngopharyngeal surgery after chemoradiotherapy.

IntroductionEndoscopic laryngopharyngeal surgery (ELPS) is an effective treatment for early-stage oropharyngeal and hypopharyngeal cancers. Since 2007, we have performed ELPS on 14 patients with early-stage cancer who had undergone radiation therapy (salvage ELPS). We discuss the beneficial effects and issues with salvage ELPS compared with those of fresh patients since we experienced some severe complications, such as ruptured pseudoaneurysm with salvage ELPS.AimTo our knowledge, the efficacy and safety of ELPS following radiation therapy have not yet been evaluated, and several unknown factors exist. An evaluation was performed for assessing whether ELPS following radiation therapy is safe, similar to findings in fresh cases previously reported by us, and whether this treatment method can be efficacious.Material and methodsWe studied the cases of 14 patients who had undergone salvage ELPS after radiation therapy for head and neck cancer at Akita University Hospital between 2007 and 2018.ResultsThe rate of recurrence of head and neck cancer at different sites after salvage ELPS was 48.9% at 2 years. Furthermore, deformation of the pharyngolarynx made it extremely difficult to perform surgery. We also experienced extremely severe complications of ruptured pseudoaneurysms.ConclusionsIf salvage ELPS is performed after radiation therapy, patients should be followed up on an outpatient basis to monitor the onset of subsequent cancers. Complications may become severe; therefore, postoperative management should be performed cautiously. In particular, vulnerable sites, such as the piriform sinus, may not be indicated for surgery. At this stage, the expectation is that patients need to be methodically selected.

Clinical outcomes of end-flexible-rigidscopic transoral surgery (E-TOS) in patients with T1-selected T3 pharyngeal and supraglottic cancers

Background: Endoscopic laryngo-pharyngeal surgery (ELPS), which is a transoral minimally invasive surgery using a gastrointestinal endoscope and a curved laryngopharyngeal retractor, is effective to treat primary lesions of superficial laryngopharyngeal cancers. To extend concepts of ELPS to invasive laryngopharyngeal cancers, we developed end-flexible-rigidscopic transoral surgery (E-TOS) from ELPS by changing a gastrointestinal endoscope to a flexible-tip rigid endoscope.Aims/Objectives: To retrospectively evaluate oncological outcomes and laryngopharyngeal functional preservation of E-TOS in patients with T1-selected T3 laryngopharyngeal cancers.Material and methods: In 47 patients T1-selected T3 pharyngeal and supraglottic cancers were resected by E-TOS using the flexible-tip rigid endoscope and curved instruments. Negative resection margin was histopathologically evaluated. The survival, preservation of larynx, and disease control rates were estimated using Kaplan-Meier method.Results: Curative resection was achieved in 94% of patients. No patient complained prolonged swallowing dysfunction or hoarseness after E-TOS. Postoperative bleeding, stenosis of the pharynx and esophageal entrance, and local recurrence was observed each in one patient. The 3-year overall survival, disease-specific survival, laryngeal preservation, local control, and locoregional control rates were, 86%, 93%, 100%, 98%, and 79%, respectively.Conclusion: E-TOS is an effective minimally invasive surgery for T1-selected T3 pharyngeal and supraglottic cancers with preserving laryngeal function.

ELPS (endoscopic laryngo-pharyngeal surgery) for superficial head and neck cancer

ELPS (endoscopic laryngo-pharyngeal surgery) for superficial head and neck cancer

An investigation on endoscopic laryngopharyngeal surgery and related outcomes.

IntroductionRobotic surgery is used in Europe and the US for oropharyngeal/hypopharyngeal cancers. Although robots can successfully perform procedures that are too delicate for surgeons and quickly learn accurate techniques, robotic surgery is not still authorized for the craniocervical region in Japan. In Japan, endoscopic laryngopharyngeal surgery (ELPS) is widely performed. Because oropharyngeal/hypopharyngeal cancer can be resected at an early stage, we have contributed to an improvement in the survival rate.AimTo analyze clinical outcomes and risk factors of postoperative cervical lymph node metastases after ELPS.Material and methodsFifty-two patients with 71 superficial oropharyngeal/hypopharyngeal cancers were included. A Sato-type arcuation laryngoscope was inserted, and oropharyngeal and hypopharyngeal fields were secured. We have recently been performing head and neck surgery using only a flexible endoscope because gastroscopy and arcuation-type forceps interfere with each other.ResultsThe 5-year survival rate was 95.2%. The risk factors of lymph node metastases were examined. The depth of the tumor significantly affected lymph node metastases.ConclusionsWith a favorable 5-year survival rate and low functional impairment, ELPS is an extremely effective form of treatment. It can provide a clear field of view in the hypopharynx and has a low cost; hence, it should be further developed as a treatment method.