Endoscopic Surgery Technique Demonstrates Cure Potential in Esophageal Cancer

Endoscopic submucosal dissection (ESD) is a safe and effective treatment for patients with superficial pharyngeal cancer, according to a study published in GIE: Gastrointestinal Endoscopy (doi:10.1016/j.gie.2015.05.043). ESD is a novel minimally invasive technique for removing lesions in the GI tract that involves cushioning the lesion and then achieving dissection from underneath it. The goal is to remove a tumor or other lesion in one piece or en bloc as much as possible. No prospective trials prior to this one are reported on the use of ESD in patients with early pharyngeal cancer, although the procedure has been used to treat some patients with the disease. Pharyngeal cancer often is detected at later stages, and the prognosis for these patients is historically poor. But recent developments in gastrointestinal endoscopy allow for earlier diagnosis of these lesions. In cases of early detection, treatment traditionally is surgery and chemotherapy. But these modalities can have negative effects on the patient's quality of life, including cosmetic deformities and/or long-term difficulties with swallowing and speech. This study included 54 patients with superficial pharyngeal cancer diagnosed between September 2010 and August 2014. Their cancers ranged from stage 0 to stage 4. The goal was to achieve a complete resection rate of 80% or higher using ESD. In this group of patients, ESD resulted in an en bloc resection rate of 100%, and a complete resection rate (en bloc resection with tumor-free margins) of 79.5%. Most adverse events, such as swelling of the site and difficulty swallowing, were temporary. Three patients had emphysema related to deeper dissection of the muscle layer. No serious adverse events were reported. Swallowing, speech and airway function were preserved in all the patients. The 3-year overall survival rate was 97.7%, and the 3-year recurrence-free survival rate was 98.1%. The authors conclude that ESD appears to be a safe and effective treatment for patients with superficial pharyngeal cancer, with minimal side effects. However, ESD is a technically demanding procedure that requires substantial training to achieve competence.