A Clinical Study of Transoral Pharyngectomies to Treat Superficial Hypopharyngeal Cancers
A Clinical Study of Transoral Pharyngectomies to Treat Superficial Hypopharyngeal Cancers
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DOI：
10.1093/jjco/hyt081
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发表时间：
2013-08-01
影响因子：
2.4
通讯作者：
Kano, Koichi
中科院分区：
文献类型：
--
作者：
Nakayama, Meijin;Katada, Chikatoshi;Kano, Koichi
背景资料：多年来，它一直是一个主要的兴趣，外科医生和肿瘤学家开发一种新的技术，以检测下咽癌在早期阶段，并治疗病变的侵入性较小的方式。窄带成像系统结合内镜和各种内镜方法的出现揭示了下咽regions.Methods的最小侵入性管理浅表癌的新时代：三个内镜方法，内镜粘膜切除术，内镜粘膜下剥离术和内镜喉咽手术，按时间顺序介绍了在我们的研究所。在这项研究中，我们专注于临床结果，优势和局限性的每一个procedure.Results：共30例（42个程序）接受经口咽切除术2006年6月至2012年5月。42例患者中有9例（21%）进行了气管切开术。三名患者出现局部复发，随后通过额外的经口咽切除术得到控制。2年和5年局部控制率分别为92.8%和83.5%。结论：内镜下黏膜切除术、内镜下黏膜下剥离术和内镜下喉咽手术联合经口咽切除术是治疗下咽浅表癌的有效方法。内镜下黏膜切除术的创伤性最小，可能有利于切除小的浅表病变，内镜下黏膜下剥离术可能有利于喉咽暴露困难的患者，内镜下喉咽手术显示出最佳的效果和最小的并发症，可以应用于大多数下咽亚部位。所有这三种手术都需要高水平的技术技能和耳鼻喉科医生和胃肠病学家之间的密切合作。
Background: 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.Methods: 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.Results: 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%.Conclusions: 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.