Long-term outcome of transoral organ-preserving pharyngeal endoscopic resection for superficial pharyngeal cancer

Background: Early detection of pharyngeal cancer has been difficult. We reported that narrow-band imaging (NBI) endoscopy can detect superficial pharyngeal cancer, and these lesions can be treated endoscopically. Objective: To assess the safety and long-term efficacy of transoral organ-preserving pharyngeal endoscopic resection (TOPER) for superficial pharyngeal cancer. Design and Setting: Retrospective 2-center cohort study. Patients: The study included 104 consecutive patients with superficial pharyngeal cancer. Intervention: TOPER with the patients under general anesthesia. Main Outcome Measurements: Safety of the procedure, long-term survival, clinical outcome. Results: A total of 148 consecutive lesions were resected in 104 patients. There was no severe adverse event. Temporary tracheostomy was required in 17 patients (16%) to prevent airway obstruction. The median fasting period and hospital stay after TOPER were 2 days (range 1-20 days) and 8 days (range 3-58 days), respectively. Ninety-six patients (92%) had no local recurrence or distant metastases. Local recurrence at the primary site developed in 6 patients, but all were resolved by repeat TOPER. With a median follow-up period of 43 months (range 3-96 months), the overall survival rate at 5 years was 71% (95% CI, 59-82). Cause-specific survival rate at 5 years was 97% (95% CI, 93-100). The cumulative development rate of multiple cancers in pharyngeal mucosal sites at 5 years was 22% (95% CI, 12-33). The pharynx was preserved in all patients, and they experienced no loss of function. Limitation: Retrospective design. Conclusions: Peroral endoscopic resection of superficial pharyngeal cancer is a feasible and effective treatment with curative intent.