Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Transoral surgery (TOS) is a common treatment of early-stage hypopharyngeal cancer, that can preserve swallowing and speech function without decreasing oncological outcomes. We often experience the difficulty of not visualizing the entire hypopharynx during TOS. In this situation, inadequate hypopharyngeal exposure may lead to incomplete tumor resection, or the operation may be abandoned. Thus, we developed the percutaneous laryngeal elevation technique (PLET) to resolve this problem. The PLET is easy to perform because it only requires the addition of a percutaneous suture on the larynx and lifting the larynx ventrally. The PLET could dramatically improve hypopharynx exposure and allow us to perform TOS on a patient with difficulty of visualizing entire hypopharyngeal cancer.
Methods: Total nine patients underwent TOS with PLET for hypopharyngeal cancer at our university from Febuluary to October in 2024. We retrospectively assessed whether PLET improved hypopharyngeal exposure and its safety. We defined hypopharyngeal exposure to four classifications as shown below. ‘Excellent vision’ was defined as unfolded pyriform sinus, non-contact between the postcricoid and posterior wall, and exposure of esophageal orifice. ‘Good vision’ was defined as unfolded pyriform sinus, non- or slight-contact between the postcricoid and posterior wall however esophageal orifice is not visualized. ‘Fair vision’ was defined as unfolded pyriform sinus, close contact between postcricoid and posterior wall. ‘Poor vision’ was defined as a limited vision by folded pyriform sinus, and close contact between postcricoid and posterior wall.
Results: Before PLET, Excellent vision, Good vision, Fair vision, and Poor vision were 0, 3, 5, and 1 respectively. After PLET, Excellent vision, Good vision, Fair vision, and Poor vision were 8, 1, 0, and 0 respectively. Improved hypopharyngeal exposure was observed in all patients by using PLET. Eight of nine patients completed TOS as planned. The operation was abandoned in one of nine patients because the tumor had spread beyond preoperative prediction. Additionally, no intra- and postoperative PLET-related complications were observed.
Conclusions: We developed a novel surgical technique, called PLET, to improve hypopharyngeal exposure during TOS for hypopharyngeal cancer. PLET could dramatically improve hypopharynx exposure and allow us to perform TOS on a patient with difficulty of visualizing entire hypopharyngeal cancer. This technique is easy and safe, which has the potential to increase the indications of TOS for hypopharyngeal cancer.