Endoscopic submucosal dissection for superficial nasopharyngeal carcinoma

Early-stage nasopharyngeal cancer is treated by radiotherapy or chemoradiotherapy [1]. Radiotherapy is less toxic than chemoradiotherapy but has a reported failure rate of 15–30 %. Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for superficial oropharyngeal and hypopharyngeal cancers [2] [3] [4], but it has not been previously performed for nasopharyngeal cancer owing to the difficulty of an endoscopic approach. This case report demonstrates ESD for nasopharyngeal lesions.

A 42-year-old man complained of throat discomfort, and papillary tumors were detected in the nasopharynx and oropharynx by nasopharyngolaryngoscopy. Biopsy specimens obtained from these lesions showed squamous cell papilloma with severe atypia. ESD was planned for total biopsy of these lesions.

The patient was transorally intubated and ESD was performed under general anesthesia. A mouth opener was placed and the uvula was pulled with a thread to secure the field of view ([Fig. 1]). An endoscope with an 8.9-mm diameter tip (GIF-H290; Olympus Corporation, Tokyo, Japan), which cannot be inserted transnasally under sedation, was used. The nasopharyngeal lesions were approached using this scope in the transnasal forward and transoral retroflex views ([Fig. 2]). En bloc resection was achieved by ESD for all four lesions using an electrosurgical knife (Flushknife 1.5 mm; FUJIFILM Medical Co., Ltd., Tokyo, Japan) ([Video 1]). He was discharged on postoperative day 4 without any adverse events.

Fig. 1 A mouth opener was placed and the uvula was pulled with a thread to secure the field of view.

Fig. 2 Endoscopic images (narrow-band imaging) of the papillary lesions in the nasopharynx a Transoral retroflex view of Lesion #1. b Transoral retroflex view of Lesion #2. c Transoral retroflex view of Lesion #3.

Video 1 Endoscopic submucosal dissection for nasopharyngeal lesions with transnasal and transoral approaches.

Histologic examinations showed an intraepithelial squamous cell carcinoma for lesion #1 of the posterior wall of the nasopharynx and papilloma for the others (lesions #2 and #3). Follow-up endoscopy 4 months after ESD showed no remnant lesion or stenosis ([Fig. 3]).

Fig. 3 No remnant lesion or stenosis was detected by follow-up endoscopy.

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Competing interests

Takashi Kanesaka has received personal fees from Olympus Corporation. Ryu Ishihara has received personal fees from Olympus Corporation and FUJIFILM Medical Co., Ltd. Other authors have no financial relationships to disclose.

• References

• 1 Cheng SH, Tsai SY, Yen KL. et al. Concomitant radiotherapy and chemotherapy for early-stage nasopharyngeal carcinoma. J Clin Oncol 2000; 18: 2040-2045
• 2 Iizuka T, Kikuchi D, Hoteya S. et al. Endoscopic submucosal dissection for treatment of mesopharyngeal and hypopharyngeal carcinomas. Endoscopy 2009; 41: 113-117
• 3 Hanaoka N, Ishihara R, Takeuchi Y. et al. Endoscopic submucosal dissection as minimally invasive treatment for superficial pharyngeal cancer: a phase II study (with video). Gastrointest Endosc 2015; 82: 1002-1008
• 4 Kinjo Y, Nonaka S, Oda I. et al. The short-term and long-term outcomes of the endoscopic resection for the superficial pharyngeal squamous cell carcinoma. Endosc Int Open 2015; 3: E266-E273

Publication History

Article published online:
01 September 2022