Risk factors for incomplete resection with pharyngeal endoscopic submucosal dissection and long-term prognosis after resection

Background Advances in endoscopic imaging technology have led to an increase in detection of superficial pharyngeal squamous carcinoma. Endoscopic submucosal dissection (ESD) has been reported to be effective for the treatment of these lesions, however there is still insufficient evidence on the long-term results of pharyngeal ESD.Methods This is a single-center retrospective study of all cases of superficial pharyngeal cancer that underwent ESD as primary treatment between January 2010 and May 2022. A total of 83 lesions in 63 patients were analyzed.Results The en bloc resection rate was 100%, and R0 resection rate was 59.0%, with an adverse event rate of 6.0%. During a mean observation period of 1134 days, there were 0 cases of disease-specific metastasis or death. However, the 5-year cumulative incidence of metachronous head and neck cancer after resection was 27.1% and the 5-year overall survival and 10-year overall survival after pharyngeal ESD were 87.0% and 69.6%, respectively. Of the 34 cases with non-R0 resection, local recurrence occurred in 8.8%. Location of lesion (p = 0.011), disparity between demarcation of the lesion with NBI and iodine staining (p = 0.026), and non-effective laryngeal elevation (p = 0.080) were risk factors for non-R0 resection.Conclusion Pharyngeal ESD is effective and safe. Further studies are needed to improve and standardize indications and strategies for pharyngeal ESD.

Automated summary

Endoscopic submucosal dissection (ESD) is an effective and safe treatment for superficial pharyngeal squamous carcinoma. However, there is a lack of sufficient evidence on the long-term outcomes of pharyngeal ESD. This retrospective study analyzed 83 cases of superficial pharyngeal cancer treated with ESD and found a high en bloc resection rate and low adverse event rate. The 5-year cumulative incidence of metachronous head and neck cancer after resection and the overall survival rates after pharyngeal ESD were also reported.