Endoscopic Laryngopharyngeal Surgery Research Articles

A Case of Simultaneous Triple Primary Cancers of the Hypopharynx, Esophagus, and Stomach Which Were Dissected by Endoscopic Laryngo-Pharyngeal Surgery Combined with Endoscopic Submucosal Dissection

A 65-year-old man was admitted to our hospital following 6 months of dysphagia. At first, conventional endoscopy showed a reddish and depressed lesion in the stomach and an elevated lesion in the posterior wall of the hypopharynx. An endoscopic biopsy showed adenocarcinoma in the stomach, and squamous cell carcinoma in the hypopharynx. On the further examination, trans-nasal endoscopy with narrow band imaging (NBI) was performed. During the trumpet maneuver, a huge protruded lesion was observed and it reached to the orifice of the esophagus. Other superficial lesion located at left pyriform sinus was detected by NBI system as brownish area with brown dots. Furthermore, superficial esophageal cancer in the cervical esophagus was detected. Finally, 4 carcinomas in upper gastrointestinal tract were detected. Among them, the hypopharyngeal cancer was the most advanced (T3N0). The patient hoped to preserve his voice and swallowing function, endoscopic laryngo-pharyngeal surgery (ELPS) was performed for the hypopharyngeal cancer. Endoscopic mucosal resection (EMR) was performed for the esophageal cancer, and Endoscopic submucosal dissection (ESD) was performed for the gastric cancer. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en-bloc. The histopathological findings of hypopharyngeal cancer were squamous cell carcinoma, subeipthelial invasion, 29 × 28 × 4.2 mm. The others were diagnosed as mucosal cancers. The patient is currently alive with no recurrence at 28 months after the surgery; there is no stricture at the cervical esophagus. Endoscopic laryngopharyngeal surgery for the tumor of pharyngo-esophageal junction can provide a less invasive treatment.

ELPS (Endoscopic Laryngo-pharyngeal Surgery) —What you need to know before you begin—

ELPS (Endoscopic Laryngo-pharyngeal Surgery) —What you need to know before you begin—

Complications After Endoscopic Laryngopharyngeal Surgery.

Endoscopic laryngopharyngeal surgery (ELPS), a hybrid of head and neck surgery and gastrointestinal endoscopic treatment, has been attracting attention as a new therapeutic modality for superficial laryngopharyngeal cancers. Although this technique is less invasive than traditional open procedures, some complications including postoperative bleeding, subcutaneous emphysema, or aspiration pneumonia can occur after treatment. The purpose of this study was to investigate the complications associated with ELPS to better understand the indications for this procedure. Retrospective medical chart review. One hundred five patients with 159 laryngeal or pharyngeal lesions were treated with ELPS between August 2009 and September 2015 at Kyoto University Hospital. In total, 147 resections were performed, and complications after the resections were reviewed. Of the 147 resections, postoperative bleeding, subcutaneous emphysema, and aspiration pneumonia were observed in 10, 17, and 10 cases, respectively. All cases with postoperative bleeding and aspiration pneumonia occurred in patients over 65 years of age. A history of taking anticoagulation/platelet medications, and macroscopic 0-IIa lesions were shown to correlate with postoperative bleeding after ELPS. Resection of lesions in the pyriform sinus was found to be associated with subcutaneous emphysema. All complications after ELPS were safely managed. A history of taking anticoagulation/platelet medications and macroscopic 0-IIa lesions were identified as risk factors for postoperative bleeding, whereas resection of pyriform sinus lesions was found to be a risk factor for subcutaneous emphysema. These risk factors should be carefully considered when treating pharyngeal and laryngeal lesions by ELPS. 4. Laryngoscope, 128:1546-1550, 2018.

ELPS が有用であった舌根部神経鞘腫の 1 例

ELPS が有用であった舌根部神経鞘腫の 1 例

Synopsis of transoral endoscopic laryngopharyngeal surgery for superficial pharyngeal cancers.

Endoscopic laryngopharyngeal surgery (ELPS) was developed for superficial pharyngeal cancers in Japan. In this study, we present our results of ELPS for superficial pharyngeal cancers. From November 2009 to December 2015, 258 patients with superficial pharyngeal cancers underwent ELPS. Results, including survival rates, postoperative complications, and vocal function, are reviewed. The median follow-up period of 258 patients was 31 months. The overall and cause-specific survival rates over 3 years were 85.7% and 100%, respectively. Only 3 patients incurred local recurrences and were successfully salvaged by re-ELPS. Regarding postoperative complications, 4 patients required reoperation because of postoperative bleeding. As for the postoperative quality of life, no patients developed vocal fold paralysis. Every patient was able to consume meals at preoperative levels. ELPS is a feasible and minimally invasive treatment for superficial pharyngeal cancers with impressive quality of life results.

Novel application of a rigid curved larygno-pharyngoscope for examination and treatment of hypopharyngeal lesions

In endoscopic laryngo-pharyngeal surgery (ELPS), a rigid curved laryngo-pharyngoscope, which was invented by Dr. Sato et al., is necessary to obtain excellent surgical view of both hypopharynx and even the entrance of the esophagus. We have used this instrument for the examination and treatment of several diseases other than cancer located in the hypopharynx, such as difficult-to-find buried fish bones, retropharyngeal abscess, and congenital pyriform sinus fistula. In the result, we could acquire better view of hypopharynx and completed the intended procedure safely, especially for uncovering difficult-to-find fish bone buried in the mucosa. Even in the cases hardly to operate under this instrument, just use for detailed observation of the lesion was available. A rigid curved laryngo-pharyngoscope provides a wide and clear view of a challenging space, the hypopharynx. We recommend using this technique in cases such as difficult-to-find buried fish bones or retropharyngeal abscesses while avoiding a neck incision.

ドセタキセル，シスプラチン，5-FUによる導入化学療法後にELPSを施行した咽頭癌症例の検討

ドセタキセル，シスプラチン，5-FUによる導入化学療法後にELPSを施行した咽頭癌症例の検討

Voice Outcome in Patients Treated With Endoscopic Laryngopharyngeal Surgery for Superficial Hypopharyngeal Cancer.

ObjectivesEndoscopic laryngopharyngeal surgery (ELPS) is a minimally invasive transoral surgery that was developed to treat superficial larygo-pharyngeal cancer, in which a mucosal lesion is resected transorally while preserving deeper structures by subepithelial injection. The purpose of this retrospective study is to evaluate voice outcome in patients who underwent ELPS for superficial hypopharyngeal cancer. As important structures in producing voice, such as intrinsic laryngeal muscles, their fascia, and recurrent laryngeal nerve, are located in the medial side of the piriform sinus and the postcricoid region of the hypopharynx, we focused on patients with cancer lesions involving these regions.MethodsFrom April 2010 to March 2011, 25 consecutive patients with superficial laryngopharyngeal cancer were treated with ELPS at Kyoto University Hospital. Among the 25 patients, 11 patients with cancer lesions on the medial side of the piriform sinus or the postcricoid area were studied. Preoperative and postoperative voice functions including maximum phonation time (MPT), mean flow rate (MFR), jitter, shimmer, soft phonation index (SPI), and noise-to-harmonic ratio (NHR), were compared retrospectively.ResultsFive of 11 cancer lesions had submucosal invasion and no lesion had invaded the muscular layer pathologically. T stage was classified as Tis in 5 cases, T1 in 4 cases, and T2 in 2 cases. All lesions involved the medial side of the piriform sinus and 2 also involved the postcricoid area. Vocal fold movement was normal in all cases after the surgery. Average preoperative and postoperative values for MPT, MFR, jitter, shimmer, SPI, and NHR, were 22.7 seconds and 23.4 seconds, 165 mL/sec and 150 mL/sec, 1.53% and 1.77%, 3.82% and 5.17%, 35.5 and 36.6, and 0.13% and 0.14%, respectively. There was no statistical difference between preoperative and postoperative data for all values examined.ConclusionELPS is useful in preserving voice function in the treatment of superficial hypopharyngeal cancer. Preserving the deeper structures including intrinsic muscles and their fascia may be important for preserving voice function as long as the lesions are superficial.

Transoral surgery for laryngo-pharyngeal cancer - The paradigm shift of the head and cancer treatment.

Transoral surgery is a less invasive treatment that is becoming a major strategy in the treatment of laryngo-pharyngeal cancer. It is a minimally invasive approach that has no skin incision and limits the extent of tissue dissection, disruption of speech and swallowing muscles, blood loss, damage to major neurovascular structures, and injury to normal tissue. Transoral approaches to the laryngo-pharynx, except for early glottis cancer, had been limited traditionally to tumors that can be observed directly and manipulated with standard instrumentation and lighting. Since the 1990s, transoral laser microsurgery (TLM) has been used as an organ preservation strategy with good oncological control and good functional results, although it has not been widely used because of its technical difficulty. Recently, transoral robotic surgery (TORS) is becoming popular as a new treatment modality for laryngo-pharyngeal cancer, and surgical robots are used widely in the world since United States FDA approval in 2009. In spite of the global spread of TORS, it has not been approved by the Japan FDA, which has led to the development of other low-cost transoral surgical techniques in Japan. Transoral videolaryngoscopic surgery (TOVS) was developed as a new transoral surgery system for laryngo-pharyngeal lesions to address the problems of TLM. In TOVS, a rigid endoscope is used to visualize the surgical field instead of a microscope and the advantages of TOVS include the wide operative field and working space achieved using the distending laryngoscope and videolaryngoscope. Also, with the spread of narrow band imaging (NBI), endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), which are widely used for superficial cancers in the gastrointestinal tract, have been applied for the superficial laryngo-pharyngeal cancer. Both EMR and ESD are performed mainly by gastroenterologists with a sharp dissector and magnifying endoscopy (ME)-NBI with minimal surgical margin. Endoscopic laryngo-pharyngeal surgery (ELPS) was developed to treat laryngo-pharyngeal superficial cancer by modifying the ESD procedure. The concept of ELPS is the same as that of ESD, however, the resection procedure is performed by a head and neck surgeon with both hands using a ME-NBI and rigid curved laryngo-pharyngoscope. These four procedures are low cost with similar oncological and functional outcomes to TORS. TORS may be less expensive than chemoradiotherapy, but the number of hospitals that can afford da Vinci surgical systems is limited. Even in the era of robotic surgery, these four procedures will be good options for laryngo-pharyngeal cancer.

Endoscopic laryngo-pharyngeal surgery for superficial laryngo-pharyngeal cancer

Narrow band imaging (NBI) combined with magnifying endoscopy enables us to detect superficial laryngo-pharyngeal cancers, which are difficult to detect by standard endoscopy. Endoscopic laryngo-pharyngeal surgery (ELPS) is a technique developed to treat such lesions and the purpose of this study is to evaluate the usefulness of ELPS for superficial laryngo-pharyngeal cancer. Seventy five consecutive patients with 104 fresh superficial laryngo-pharyngeal cancers are included in this study. Under general anesthesia, a specially-designed curved laryngoscope was inserted to create a working space in the pharyngeal lumen. A magnifying endoscope was inserted transorally to visualize the field and a head & neck surgeon dissected the lesion using the combination of the orally-inserted curved grasping forceps and electrosurgical needle knife in both hands. The safely, functional outcomes, and oncologic outcomes of ELPS were evaluated retrospectively. Median operation time per lesion was 35 min. Post-operative bleeding occurred in 3 cases and temporal subcutaneous emphysema occurred in 10 cases. No vocal fold impairment occurred after surgery. The median fasting period was 2 days and all patients except one have a normal diet with no limitations. Local recurrence occurred in 1 case, and the 3-year overall survival rate and the 3-year disease specific survival rate was 90% and 100%, respectively. ELPS is a hybrid of head and neck surgery and gastrointestinal endoscopic treatment, and enjoys the merit of both procedures. ELPS makes it possible to perform minimally-invasive surgery, preserving both the swallowing and phonation functions.

Abstract 50: HOXB9 expression associate with lymphatic invasion in superficial pharyngeal carcinoma

Abstract Background: Early diagnosis and early treatment are the best ways to improve cancer patient prognoses and keep quality of life of the patients after treatment. We developed ELPS (endoscopic laryngo-pharyngeal surgery) as an endoscopic treatment for superficial pharyngeal carcinoma. ELPS was performed on 278 patients of superficial carcinoma of the pharynx. However 18 lesions have lymphatic invasion, and lymphatic metastasis have occurred in 10 patients after ELPS. HOXB9, a member of the HOX genes, has been reported to be overexpressed in some neoplastic tissues. The class I HOXB gene family consists of 39 members with a shared and highly conserved 61-amino acid homeodomain motif. These genes are significant regulators of development, and their roles in neoplastic transformation and tumor progression have been recognized. Some studies have suggested that HOXB9 expression promotes cellular invasiveness, metastatic ability, and tumor vascularization in the surrounding tissue by inducing EMT. These findings imply that HoxB9 overexpression may alter tumor-specific cell fates and the tumor stromal microenvironment, contributing to lymphatic invasion of superficial carcinoma. The objective of this study is to analyze whether HOXB9 expression associates with lymphatic invasion and causes in lymph node metastasis of superficial pharyngeal carcinoma. METHODS: A total of 36 superficial pharyngeal carcinoma patients who underwent endoscopic surgery were examined. Immunohistochemical staining was performed to evaluate the expression of HoxB9, and the association of lymphatic invasion and lymph node metastasis with HoxB9 expression was analyzed. RESULTS: Of the 36 superficial pharyngeal carcinoma specimens, depth of tumor invasion is epithelial layer (EP) in 19 tumors and submucosal layer (SEP) in 17 tumors. Thirteen of 19 (68.4%) EP tumors showed HoxB9 expression, and 10 of 17 (58.8%) SEP tumor showed HOXB9 expression. There is no significant correlation of HOXB9 expression and depth of tumor invasion. Six of the 36 tumors have lymphatic invasion. All tumors having lymphatic invasion showed positive HoxB9 expression, whereas 17 of 30 having no lymphatic invasion showed HoxB9 expression. HoxB9 positive tumors tend to have lymphatic invasion (p=0.07). Five of the 36 patients have lymphatic metastasis. Four of 5 patients (80%) who have lymph node metastasis showed positive HoxB9 expression, whereas 19 of 31 (61.3%) who have no lymph node metastasis showed HoxB9 expression. HOXB9 positive tumors tend to have lymphatic invasion. Conclusions: Our results suggest that HOXB9 can play a significant role in lymphatic invasion of superficial pharyngeal carcinoma and can be a novel molecular maker for the lymphatic metastasis. Citation Format: Hirofumi Kawakubo, Mai Tsutsui, Rieko Nakamura, Tsunehiro Takahashi, Norihito Wada, Yoshiro Saikawa, Tai Omori, Hiroya Takeuchi, Yuko Kitagawa. HOXB9 expression associate with lymphatic invasion in superficial pharyngeal carcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 50. doi:10.1158/1538-7445.AM2014-50

A patient with rapid growth of superficial-type poorly differentiated hypopharyngeal squamous cell carcinoma

An 81-year-old man was diagnosed as having cStage IVa esophageal cancer and treated by chemoradiation therapy. His treatment response to the CRT was classified as CR. Then, 34 months after the CRT, he was detected to have a small elevated lesion with abnormal blood vessels coursing over it in the rt pyriform sinus, with the lesion showing rapid increase in size to a clearly elevated lesion over the next 6 months. The surface of the lesion was covered by normal mucosa and blood vessels (Type B2) could be seen coursing over it by magnifying endoscopy with NBI. We diagnosed the lesion as a superficial hypopharyngeal cancer (Type 0-I+IIa) and performed endoscopic laryngo-pharyngeal surgery. The pathological diagnosis was poorly differentiated squamous cell carcinoma with ly1, v1, and prominent subepithelial invasion. Pharyngeal cancer is often found synchronously or metachronously in patients with esophageal cancer, presumably as a result of the shared risk factors between the two cancers, such as alcohol drinking, smoking and deficient ALDH2 activity. Endoscopic examination to detect any pharyngeal cancer must be performed in esophageal cancer patients with the aforementioned risk factors. Diagnosis of a pharyngeal elevated lesion is often difficult due to the presence of the tonsils and lymphoid follicles. Therefore, careful magnifying endoscopy with NBI should always be performed to confirm the presence/absence of blood vessels coursing over small and slightly elevated lesions.

A Clinical Study of Transoral Pharyngectomies to Treat Superficial Hypopharyngeal Cancers

For years, it has been a major interest for surgeons and oncologists to develop a novel technique to detect hypopharyngeal cancers at an early stage and to treat the lesions in a less invasive manner. The advent of the narrow band imaging system combined endoscopy and various endoscopic approaches shed light on the new era of the minimum invasive management of superficial cancers in hypopharyngeal regions. Three endoscopic approaches, endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic laryngopharyngeal surgery, were chronologically introduced at our institute. In this study, we focused on the clinical outcomes, advantages and limitations of each procedure. A total of 30 patients (42 procedures) received transoral pharyngectomies between June 2006 and May 2012. Tracheotomy was performed in 9 of 42 (21%) patients. Three patients developed local recurrence and were subsequently controlled by additional transoral pharyngectomies. The 2- and 5-year local control rates were 92.8 and 83.5%. The 2- and 5-year overall survival rates were 82.1%. Endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic laryngopharyngeal surgery-transoral pharyngectomies are useful procedures for treating superficial hypopharyngeal cancers. Endoscopic mucosal resection manifested the least invasiveness and may be beneficial for resecting small superficial lesions, endoscopic submucosal dissection may be advantageous for patients with difficult laryngopharyngeal exposure and endoscopic laryngopharyngeal surgery has shown the optimal effectiveness and minimal complications and can be applied to most of the hypopharyngeal sub-sites. All three procedures require a high level of technical skill and close collaboration between otolaryngologists and gastroenterologists.

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

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.

New endoscopic treatment for superficial carcinoma of borderline lesions between the cervical esophagus and hypopharynx.

107 Background: Early diagnosis and early treatment are the best ways to improve cancer patient prognoses. We developed ELPS (endoscopic laryngo-pharyngeal surgery) as an endoscopic treatment for superficial pharyngeal carcinoma. ELPS is transoral endoscopic surgery for laryngeal cancer. After lifting the larynx using the laryngoscope, the endoscopist inserts endoscope and the operator inserts forceps and electric device transorally, and resects superficial phayngeal carcinoma. However, ELPS has not been applied for cervical esophagus carcinoma because of the narrow working space. We developed a hybrid endoscopic surgery (ESD+ELPS) for borderline lesions between the cervical esophagus and hypopharynx. The purpose of this study was to examine the usefulness and effectiveness of endoscopic treatment for superficial carcinoma of the hypopharynx and cervical esophagus. Methods: Hybrid endoscopic surgery (ESD and ELPS) was performed on 8 lesions, which involved both the hypopharynx and cervical esophagus. Results: Six of eight patients had esophageal cancer treatments in their past histories, two for ESD, two for esophagectomy and two for chemoradiation. All lesions were completely resected. The complications of this procedure were laryngeal edema for three patients, which required overnight intubation, and stenosis of cervical esophagus for two patients, which required endoscopic dilation more than 10 times. There were no long term complications in all patients. Conclusions: 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.

Second primary malignancy in patients with long survival after esophagectomy for squamous cell carcinoma of the esophagus.

42 Background: Patients after esophagectomy for esophageal squamous cell carcinoma (ESCC) were reported to have a remarkably high risk of subsequent cancer of head and neck cancer (Matsubara, et al. J Clin Oncol 2003). The outcome was reported to be significantly less favorable as a result of difficulty in early detection. However, magnifying endoscopy combined with narrow band imaging (NBI) system recently allowed early detection of head and neck cancer. This study was to assess the risk of subsequent malignancies after esophagectomy for ESCC for the establishment of an adequate follow-up program. Methods: Eighty patients with ESCC who had undergone radical esophagectomy at the Kawasaki Municipal Hospital from 2000 to 2006 were eligible for this study. Among the eighty patients, we analyzed 41 cases who survived more than 5 years after esophagectomy. Results: Median survival of the 41 patients was 7.1 years. Two patients who developed squamous cell carcinoma in the lung within 5 years after esophagectomy were not included in the group of subsequent second malignancies, because it was difficult to distinguish primary tumors from metastatic tumors. Second malignancies were found in 7 (17.1%) of 41 patients subjected to curative esophagectomy. Subsequent malignancies were most frequently found in the head and neck region (n = 4; 57.1%), followed by the residual esophagus (n = 1; 14.3%), colon (n = 1; 14.3%), and breast (n = 1; 14.3%). The subsequent cancers in head and neck, and residual esophagus were detected from 1 to 9 years after esophagectomy in an early stage with magnifying endoscopy combined with NBI system. They were curatively resected by endoscopic laryngo-pharyngeal surgery (ELPS) and endoscopic submucosal dissection (ESD). The subsequent cancers in colon and breast were also curatively resected by operation. Conclusions: Patients after esophagectomy for ESCC had a high risk of subsequent cancer of head and neck cancer. Minute postoperative surveillance with magnifying endoscopy combined with NBI system is strongly recommended even more than 5 years after esophagectomy. Early detection of second malignancies allowed less invasive treatment such as ELPS and ESD with favorable outcome.

Endoscopic treatment for superficial squamous cell carcinoma in the head and neck region (HNSCC)

16542 Background: The HNSCC are usually diagnosed at advanced stage, therefore, the prognosis is dismal. Recently we can find the superficial HNSCC by using high-resolution and magnifying endoscopy. We expect to get a good prognosis by the endscopic treatment (EMRC: Endoscopic Mucosal Resection by Cap-method/ELPS: Endoscopic Laryngo-Pharyngeal Surgery) for the superficial HNSCC. The purpose of this study is to examine the usefulness and effectiveness of endoscopic treatment for the superficial HNSCC. Methods: The superficial HNSCC means that the depth of cancer invasion is within the subepithelial layer. When we diagnose superficial HNSCC with no lymphnode metastasis, the endoscopic treatment (EMRC/ELPS) becomes the first line treatment under general-anesthesia. For those treatment cases, We examine the method of treatment, complication, pathological diagnosis and prognsis. Result: We have 130 patients (201 lesions) of the superficial HNSCC from Jan 2000 to Jan 2007. The endoscopic treatment cases were 92 (142 lesions), 87 male and 5 female, ranging in age from 40 to 86 years. Of the 92 patients, 56 (60.9%) had been treated by EMRC, 36 (39.1%) had been treated by ELPS. EMRC is good for small lesion (less than 10 mm in diameter). ELPS is suitable for large lesion. In EMRC case, a wound pain was often slight after the operation, and patient could leave the hospital in 4–5POD. In ELPS case, a wound pain was stronger than EMRC, and needed more hospital days. Major complication was not recognized both in EMRC and ELPS. Of 142 lesions which clinical assessments of the depth of cancer invasion were ep (epithelial layer) or sep (subepithlial layer), 140 lesions (98.6%) were histopathologically ep or sep. Two lesions (1.4%) were mp (proper muscular layer). Of the 92 patients, 83 are alive, 9 had been dead. There was no lymphnode metastasis, distant metastasis and local recurrent case. Forty patients of 3 years observation were accrued from Jan 2000 to Dec 2003. Of the 40 patients, 33 were alive, 7 were dead. No HNSCC patients died. The cause specific 3 years survival rate is 100%. Conclusion: The result of our trial indicated the usefulness of endoscopic treatment for superficial HNSCC and the effectiveness for improving the prognosis of HNSCC No significant financial relationships to disclose.

下咽頭表在癌の手術治療―内視鏡的咽喉頭手術（ＥＬＰＳ）の経験

Superficial carcinoma of the esophagus is generally treated with endoscopic mucosal resection (EMR), yielding an acceptable prognosis and quality of life (QOL). With technical advances in endoscopy, it has become to possible to find superficial carcinoma even in the hypopharynx. Several reports suggest that such superficial carcinomas are treatable only with local mucosal resection. We treated 67 superficial carcinomas (49 cases) of the hypopharynx with local mucosal resection in our hospital, mainly with EMR. From 2004, we have resected 11 lesions directly with endoscopic assist (endoscopic laryngo pharyngeal surgery; ELPS). With ELPS, it was very easy to recognize lugol-voiding lesions in the hypopharynx, and ELPS enabled us to do en bloc resection even for large lesions that could not be treated with EMR or with microscopic surgery. Eight of 49 cases had transient side effects-2 vocal cord palsies, 2 vocal cord edemas with overnight intubation, 3 overnight intubations, and 1 pharyngitis. Six patients died of other diseases, and no metastasis or recurrence of superficial carcinoma was found. Diagnosis and treatment of superficial carcinoma of the hypopharynx may thus improve patient prognosis and QOL.