LAUSR

ADVANCES IN ENDOSCOPY technologies have enabled treatment of superficial pharyngeal cancer. Specifically, endoscopic submucosal dissection (ESD), which is performed cooperatively between head and neck surgeons and endoscopists, has enabled minimally invasive surgery. Usually, pharyngeal ESD is performed under general anesthesia using an endotracheal tube and a curved laryngoscope to expand the working space. An 81-year-old man underwent tracheostomy and total laryngectomy for hypopharyngeal cancer. Surveillance esophagogastroduodenoscopy revealed a flat elevated lesion with an 18 mm diameter in the posterior pharyngeal wall; biopsy showed high-grade dysplasia. We suspected superficial pharyngeal cancer on magnifying endoscopy with narrow band imaging (Fig. 1a–c). Since the trachea and esophagus were completely separated after tracheostomy and total laryngectomy, there seemed to be little chance of aspiration (Fig. 2). Furthermore, the view was good due to the lesion in the posterior wall; a laryngoscope was not required. We performed ESD without general anesthesia and without intubation for minimally invasive surgery (Video S1, Fig. 1d–g). The procedure was performed using propofol plus dexmedetomidine as intravenous sedation and using a GIF-Q260J (Olympus, Tokyo, Japan) with the attachment (D-201-11804; Olympus) and sodium hyaluronate as submucosal injection. A clip with thread was used as the traction device and an autologous fibrin glue and polyglycolic acid sheet were used to prevent delayed bleeding and perforation. Second-look endoscopy was performed on postoperative day (POD) 4, where the pharyngeal ulcer was covered with thick whitish exudate; food intake resumed. He was discharged on POD 6, with no adverse events. Histopathology revealed squamous cell carcinoma in situ (tumor thickness, 350 lm) with negative margins; a 4-month follow-up showed an ulcer scar with no local recurrence (Fig. 1h,i). Endoscopic submucosal dissection without intubation is a minimally invasive treatment option for superficial pharyngeal carcinoma after total laryngectomy. Authors declare no conflict of interest for this article.