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

Sep 24, 2026

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Advances in endoscopic imaging have increased detection of superficial pharyngeal squamous carcinoma, yet long-term evidence for pharyngeal endoscopic submucosal dissection (ESD) remains limited. A single-center retrospective analysis included all primary ESD cases of superficial pharyngeal cancer from January 2010 to May 2022, totaling 83 lesions in 63 patients. Results showed 100% en bloc resection, 59.0% R0 resection, 6.0% adverse events, and no disease-specific metastasis or death during a mean follow-up of 1134 days.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Abstract

Background

Methods

Study design

Patients

Results

Conclusion

Risk factors for incomplete resection with pharyngeal endoscopic submucosal dissection and long‑term prognosis after resection Yoshiki Sakaguchi1 · Yuki Saito2 · Mizuo Ando2 · Masafumi Yoshida2 · Osamu Fukuoka2 · Kenya Kobayashi2 · Dai Kubota1 · Daisuke Ohki1 · Hiroya Mizutani1 · Keiko Niimi1 · Yosuke Tsuji1 · Mitsuhiro Fujishiro1 · Tatsuya Yamasoba2 Received: 10 August 2022 / Accepted: 5 December 2022 / Published online: 9 January 2023 © The Author(s) 2023 Abstract 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. Keywords Pharyngeal cancer · Endoscopic submucosal dissection · Incomplete resection · Prognosis · Diagnosis Advances in endoscopic imaging technology and increasing attention to pharyngeal cancer during screening endoscopy have led to an increase in detection of superficial pharyngeal squamous carcinoma [1, 2] . This in turn has enabled minimally invasive methods of treatment for superficial pharyngeal cancer, such as endoscopic submucosal dissection (ESD) and endoscopic laryngo-pharyngeal surgery (ELPS)[3–11] . In these procedures, the horizontal demarcation of the lesions is diagnosed and marked using high-definition upper gastrointestinal (GI) endoscopes, and this is followed * Yoshiki Sakaguchi [sakaguchiy-int@h.u-tokyo.ac.jp](sakaguchiy-int@h.u-tokyo.ac.jp) 1 Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan 2 Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan by local resection of the marked area. Thus, these methods are similar in concept, and have been reported to have comparable results. Especially ESD, which is widely performed worldwide for superficial neoplasms in the GI tract, has already been adopted in many facilities not only in Japan, but also in other countries in Asia and Europe [3–9] . As there is a low risk of recurrence even in cases where R0 resection cannot be pathologically confirmed [3, 12], there is limited literature assessing risk factors for the relatively low R0 resection rate in pharyngeal ESD. However, the risk of postoperative recurrence is not negligible in these cases, and there is a need to clarify risk factors for incomplete resection. Incomplete resection has been mainly attributed to cauterization of the edges of the specimen during the resection process [3 , 6] but there is also a possibility that inaccurate extent diagnosis of superficial lesions may also attribute to the low R0 resection rate. While resection of wider margins may reduce the risk of incom

FAQs

What was the study design and time span for the pharyngeal ESD cases analyzed?

The study used a single-center retrospective design, including all consecutive primary ESD cases of superficial pharyngeal cancer treated between January 2010 and May 2022.

What were the key resection outcomes and adverse event rates?

The en bloc resection rate was 100%, the R0 resection rate was 59.0%, and the adverse event rate was 6.0%.

Which factors were identified as risk factors for non-R0 (incomplete) resection?

Risk factors included lesion location (p = 0.011) and disparity between lesion demarcation with NBI and iodine staining (p = 0.026). Non-effective laryngeal elevation showed a less definitive association (p = 0.080).

Sep 24, 2026

Uploaded by Ezra