Endoscopic submucosal dissection for the treatment of synchronous hypopharyngeal mass and esophageal superficial carcinoma

Excerpt

A 53-year-old man with a history of smoking (1 pack/day × 30 years) and massive alcohol intake (250 g/day × 30 years) presented to our hospital with abnormal pharyngeal sensation and dyspnea. On esophagogastroscopy, a 2-cm pedunculated mass with hyperemia was observed in the right aryepiglottic fold (Fig. 1a), and a flat-type lesion was also identified 16 cm from the incisors (Fig. 1b). After endoscopic biopsy, a diagnosis of synchronous hypopharyngeal and esophageal squamous cell carcinoma was made. Subsequent computerised tomography (CT) of the neck revealed an approximately 2.3 × 1.6 cm well-defined mass in the right aryepiglottic fold (Fig. 1c), without cervical lymph node metastases. A contrast-enhanced CT of the chest did not reveal significant abnormality. Considering the fact that synchronous surgical resection of both the cancers is highly invasive treatment with high complication rates [1], and the patient refused to undergo staged treatment, endoscopic submucosal dissection (ESD) was performed for both the cancers  during a single procedure (Fig. 1d–f). The patient was placed in a supine position and intubated. Elevation of larynx was performed to make good endoscopic field. The ESD technique used for hypopharyngeal mass was the same as that used for gastrointestinal carcinoma (Video 1). The total procedure time was 132 min. No severe complication was noted during the procedure. Histopathology of the resected mass revealed the tumor to be a well-to-moderately differentiated squamous cell carcinoma, invading the muscularis propria layer (Fig. 1g), and the esophageal lesion was squamous epithelium accompanied by regional high-grade intra-epithelial neoplasia (Fig. 1h). Both specimens were judged to have negative lateral and vertical margins. At 1-month follow up, esophagogastroscopy showed white scars at the dissection sites (Fig. 2). Considering the risk of lymph nodes or cancer metastases, the patient was then hospitalized for chemoradiotherapy. Long-term follow up of the patient was needed.

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