Long-term outcomes of endoscopic submucosal dissection versus laryngectomy for superficial hypopharyngeal cancer: A propensity-score matching analysis
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Background: Endoscopic submucosal dissection (ESD) has recently been reported as an alternative to open surgery for superficial hypopharyngeal cancer. This retrospective analysis compared outcomes between patients treated with ESD and those undergoing open surgery, with a particular focus on long-term efficacy. Methods: This was a single-center retrospective cohort study. Patients who underwent ESD or partial/total laryngectomy for hypopharyngeal squamous cell carcinoma between April 2015 and December 2020 were retrospectively analyzed. Long-term outcomes were compared between the two groups. Results: A total of 49 patients with hypopharyngeal cancer, with a median follow-up of 61 months (range 52–82), were included. Twenty patients underwent ESD, and 29 underwent open surgery. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to equilibrate T stages across both cohorts. After IPTW adjustment, the R0 resection rates were 75.9% in the ESD group and 90.0% in the surgery group (P = 0.249). Compared with surgery, ESD was associated with a significantly shorter hospitalization (median 4 vs. 18 days, P < 0.001), as well as lower incidences of tracheal fistula and vocal cord dysfunction. The 5-year progression-free survival rate was identical in both groups at 65.5% (P = 0.916). Conclusion: ESD represents a viable therapeutic alternative for superficial hypopharyngeal cancers, offering superior quality-of-life outcomes compared with conventional surgery, without compromising long-term survival.
Abstract
Background: Endoscopic submucosal dissection (ESD) has recently been reported as an alternative to open surgery for superficial hypopharyngeal cancer. This retrospective analysis compared outcomes between patients treated with ESD and those undergoing open surgery, with a particular focus on long-term efficacy. Methods: This was a single-center retrospective cohort study. Patients who underwent ESD or partial/total laryngectomy for hypopharyngeal squamous cell carcinoma between April 2015 and December 2020 were retrospectively analyzed. Long-term outcomes were compared between the two groups. Results: A total of 49 patients with hypopharyngeal cancer, with a median follow-up of 61 months (range 52–82), were included. Twenty patients underwent ESD, and 29 underwent open surgery. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to equilibrate T stages across both cohorts. After IPTW adjustment, the R0 resection rates were 75.9% in the ESD group and 90.0% in the surgery group (P = 0.249). Compared with surgery, ESD was associated with a significantly shorter hospitalization (median 4 vs. 18 days, P < 0.001), as well as lower incidences of tracheal fistula and vocal cord dysfunction. The 5-year progression-free survival rate was identical in both groups at 65.5% (P = 0.916). Conclusion: ESD represents a viable therapeutic alternative for superficial hypopharyngeal cancers, offering superior quality-of-life outcomes compared with conventional surgery, without compromising long-term survival.