Endoscopic submucosal dissection of cervical esophageal cancer with hypopharyngeal invasion using a curved laryngoscope

Abstract Background We sometimes experience cases of cervical esophageal cancer which requires laryngectomy due to spread of cancer to larynx. We report a case of esophageal cancer resection with preservation of larynx using intraoperative endoscopic submucosal dissection. Methods The patient was a 59-year-old woman who had dysphagia. She had received total gastrectomy with Roux-en-Y reconstruction for gastric cancer in 2001, chemoradiation (61.2Gy) for esophageal cancer in 2008. Argon plasma coagulation (APC) was performed for the carcinoma in situ of cervical esophagus in 2016. This time superficial 0-IIc tumor was observed at the same site of the scar of APC, and a biopsy revealed squamous cell carcinoma. An endoscopic findings revealed two 0-IIc lesions at distance of 18–22 cm, and 32–34 cm from the incisors, and biopsy resulted in a diagnosis of squamous cell carcinoma. Since tumor was close to the esophageal orifice, the tumor invasion to the larynx was suspected. On the other hand, there were no obvious findings of the submucosal layer invasion, and the both tumor were thought to be limited to the epithelium or lamina propria mucosae (EP/LPM). We performed mediastinoscopic and thoracoscopic transhiatal esophagectomy, subcutaneous ileocolic reconstruction. Results After confirming the tumor invasion to the esophageal orifice by chromoendoscopy with 1% Lugol's iodine solution, we dissected the whole circumference of esophagus in submucosal layer just above the tumor by ESD, put an incision outside of esophageal wall, and resected the esophagus. We preserved short length of muscle layer and performed reconstruction with hypopharynx-ileum anastomosis. Pathological examination revealed squamous cell carcinoma, pT1a-EP, ly0, v0, pPM0, pDM0, pIM0, and curative resection was performed. The postoperative course was uneventful. Conclusion There were no reports of successful larynx-preserving surgery for cervical esophageal cancer using intraoperative ESD. When the tumor was limited in the mucosa, esophagectomy with intraoperative ESD may enable larynx preservation even if the tumor invaded to the esophageal orifice. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Case of Superficial Cancer Located at the Pharyngoesophageal Junction Which Was Dissected by Endoscopic Laryngopharyngeal Surgery Combined with Endoscopic Submucosal Dissection

Case Reports in Otolaryngology ◽

10.1155/2017/1341059 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Kenro Kawada ◽

Tatsuyuki Kawano ◽

Taro Sugimoto ◽

Kazuya Yamaguchi ◽

Yuudai Kawamura ◽

...

Keyword(s):

Esophageal Cancer ◽

Endoscopic Submucosal Dissection ◽

Head And Neck ◽

Anterior Wall ◽

Transoral Surgery ◽

Cervical Esophageal Cancer ◽

En Bloc ◽

Swallowing Function ◽

Transnasal Endoscopy ◽

Submucosal Dissection

Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here.Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection.Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection.Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction.

Download Full-text

Successful endoscopic submucosal dissection using the water pressure method for cervical esophageal cancer

Digestive Endoscopy ◽

10.1111/den.13973 ◽

2021 ◽

Author(s):

Teppei Masunaga ◽

Motohiko Kato ◽

Naohisa Yahagi

Keyword(s):

Esophageal Cancer ◽

Endoscopic Submucosal Dissection ◽

Water Pressure ◽

Cervical Esophageal Cancer ◽

Pressure Method ◽

Submucosal Dissection

Download Full-text

147 EFFECTIVE UNDERWATER ENDOSCOPIC SUBMUCOSAL DISSECTION FOR A SUPERFICIAL CERVICAL ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doaa087.27 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

S Sasaki ◽

N Ishigaki ◽

T Harada ◽

H Hanada

Keyword(s):

Esophageal Cancer ◽

Endoscopic Submucosal Dissection ◽

Muscularis Propria ◽

Dentate Line ◽

Cervical Esophageal Cancer ◽

Good View ◽

Submucosal Dissection ◽

Duodenal Lesions ◽

Esophageal Lesion ◽

Narrow Space

Abstract Underwater method is now mainly used in endoscopic mucosal resection of colorectal and duodenal lesions based on the fact that mucosa and submucosa float into the lumen moving away from the muscularis propria after filling with water without submucosal injection. We performed underwater endoscopic submucosal dissection (ESD) for a cervical esophageal lesion. Methods Case report. Results An 81-year-old man with a history of drinking and smoking underwent endoscopy, revealing a 1/3 round superficial cancer in the cervical esophagus. ESD was performed under general anesthesia and tracheal intubation. The lumen was so narrow from natural constriction that a good view could not be secured under CO2 insufflation. Therefore, we tried the underwater method. As the lumen was expanded by filling with 0.9% saline solution, it was possible to secure a visual field. Because the submucosal layer floated up underwater, a circumferential incision and submucosal dissection were completed easily and quickly. Conclusion Endoscopic resection for lesions within a physiologic narrow space is difficult. The underwater method is reported to be useful for treatment of rectal tumors near the dentate line and cecal tumors in the appendiceal orifice. We found that the underwater method made ESD for the cervical esophageal cancer even easier by securing a good view. To our knowledge, this is the first report of underwater ESD for a cervical esophageal cancer.

Download Full-text