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.
Endoscopy_UCTN_Code_CPL_1AH_2AZ
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