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

Abstract

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.

Chinese abstract

背景：内窥镜喉咽手术（ELPS）是一种使用胃肠内窥镜和弯曲的刚性喉部牵开器的经口微创手术, 可有效治疗浅表喉咽癌的原发病灶。为了将ELPS的概念扩展到侵入性喉咽癌, 我们将胃肠内窥镜改为柔端刚性内窥镜, 开发了内 – 柔性 - 刚性镜经口手术（E-TOS）。

目的：回顾性评价T1-所选T3喉咽癌患者的肿瘤学结果和E-TOS的喉咽功能保留情况。

材料和方法：使用柔端刚性内窥镜和弯曲器械, 通过E-TOS切除47名患者的T1-所选T3咽和声门上型癌。对阴性切除边缘进行组织病理学评估。使用Kaplan-Meier方法评估存活率、喉保存率和疾病控制率。

结果：94％的患者取得了根治性切除。没有患者抱怨E-TOS手术后吞咽功能障碍或声音嘶哑。术后出血、咽部和食管入口狭窄以及局部复发分别发生于一名患者。 3年总生存率、疾病特定性存活率、喉保存、局部控制和局部区域控制率分别为86％、93％、100％、98％和79％。

结论：E-TOS是一种有效的治疗T1-所选T3咽喉和声门上型喉癌的微创手术, 具有喉保留功能。

Keywords:

• Endoscopic surgery
• endoscope
• transoral surgery
• pharyngeal cancer
• laryngeal cancer
• supraglottic cancer
• minimally invasive surgery

Acknowledgements

We sincerely thank Dr. Ryo Asato, Department of Otolaryngology-Head & Neck Surgery, Kyoto Medical Center, to teach the technique and provide an opportunity for this surgical method.

Disclosure statement

No potential conflict of interest was reported by the authors.