Feasibility of a "resect and watch" strategy with endoscopic resection for superficial pharyngeal cancer

Abstract

Background: After endoscopic resection (ER) for superficial pharyngeal cancer (SPC), additional treatments such as radical surgical resection or radiation therapy may be needed in cases of possible incomplete resection. However, the benefit of prophylactic additional treatment is unclear.

Objective: To evaluate the feasibility of a "resect and watch" strategy with ER for SPC.

Design: Retrospective, single-center cohort study.

Setting: Tertiary cancer center.

Patients: A total of 32 patients with 47 SPCs were eligible.

Intervention: A "resect and watch" strategy of initial ER and observation until development of secondary diseases, including local recurrence, neck lymph node metastasis (LNM), and metachronous pharyngeal cancer.

Main outcome measurements: Complications, tumor recurrence, development of metachronous pharyngeal cancer, overall survival, and cause-specific survival.

Results: There were no severe complications related to ER. Median length of follow-up was 43 months (range, 7-76 months). Cumulative development of secondary diseases at 5 years was 44% (95% CI, 24.5%-63.8%). Local recurrence (N = 4) and neck LNM (N = 5) were successfully treated by local resection (2 partial surgical resections and 2 additional ERs) and neck dissection, respectively. Metachronous pharyngeal cancers (N = 6) were completely removed by ER. The overall survival and cause-specific survival rates at 5 years were 84.4% (95% CI, 70.0%-98.8%) and 100%, respectively. No patient needed radical surgery as an additional therapy. Thus, the larynx and its function were preserved in all patients.

Limitations: Retrospective nature, single-center setting, relatively small sample size.

Conclusions: A "resect and watch" strategy with ER for SPC is feasible and rational.