PMC9841794_01
a Intraoperative endoscopic images after tracheal intubation show a thick, elevated lesion at the posterior wall of the hypopharynx. b At the apex of the lesion, the mucosa disappears, forming an ulcer. c A PET-CT shows a right internal deep cervical lymph node swelling, and there is intense FDG uptake (SUV max 4.1) (Yellow arrow). d The primary site, immediately after ELPS combined with ESD. The lesion is completely resected. e Two months following ELPS combined with ESD. The ulcer has completely healed without significant deformation. f Two months following ELPS combined with ESD. Endoscopy confirms no residual recurrence, but contrast-enhanced CT shows submucosal mass formation in the primary site (Yellow arrow).
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F2
Esophagogastroduodenoscopy revealed a thick, flat, elevated lesion with ulcerative changes in the posterior wall of the hypopharynx (shown in Fig. 2a, b). Additionally, contrast-enhanced computed tomography revealed right internal deep cervical lymph node swelling, and intense fluorodeoxyglucose (FDG) uptake was observed in the swollen lymph nodes (shown in Fig. 2c). After the preoperative examination was completed, the patient's hypopharyngeal cancer was first removed within 150 min by ELPS combined with ESD (shown in Fig. 2d). Two months following ELPS combined with ESD, the sore throat associated with resection alleviated, and the mucosal defect healed completely (shown in Fig. 2e), while a preoperative examination for lymph node dissection revealed submucosal local recurrence (shown in Fig. 2f).
a Histology of the resected specimen shows the tumor invading the subepithelial layer (invasion depth 8,000 mum) with negative vertical resection margin. b Histology of the resected specimen also shows that the lateral margins were negative. c A cluster of squamous cell carcinoma was found in the lymph vessel.
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F3
Pathologic evaluation of the resected specimen confirmed that a well-differentiated SCC invaded subepithelial layer (invasion depth 8,000 mum) with negative lateral and vertical resection margins (shown in Fig. 3a, b). A cluster of SCC was found in the lymph vessels in the subepithelial layer (shown in Fig. 3c).
PMC9841794_02
a Intraoperative endoscopic images after tracheal intubation show a thick, partially flat elevated lesion at the posterior wall of the hypopharynx. b A PET-CT shows a left internal deep cervical lymph node swelling, and there is intense FDG uptake (Yellow arrow). c The primary site, immediately after ELPS combined with ESD. The lesion is completely resected. d Two months following ELPS combined with ESD. The ulcer has completely healed without significant deformation.
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F4
Esophagogastroduodenoscopy revealed a distorted elevated lesion in the posterior wall of the hypopharynx (shown in Fig. 4a), and the biopsy specimen revealed a well-differentiated SCC. In addition, there was intense FDG uptake in the swollen lymph node (shown in Fig. 4b). During the 9-day hospital stay, the primary lesion was resected without adverse events in ELPS combined with ESD (shown in Fig. 4c). Fig. 4d). Forty-two months after the treatment, the patient was recurrence-free and survived without any additional treatment.
PMC9841794_03
a Intraoperative endoscopic images after tracheal intubation show a distorted protruded lesion on the left arytenoid. b A PET-CT shows a left internal deep cervical lymph node swelling, and there is intense FDG uptake (SUV max 4.7) (Yellow arrow). c The primary site, immediately after ELPS combined with ESD. The lesion is completely resected. d Two months following ELPS combined with ESD. The ulcer has completely healed without significant deformation.
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F5
Esophagogastroduodenoscopy showed a distorted protruding lesion on the left arytenoid (shown in Fig. 5a), and the biopsy specimen revealed a well-differentiated SCC. PET-CT showed left internal deep cervical lymph node swelling and intense FDG uptake in the swollen lymph node (shown in Fig. 5b). It took approximately 140 min to remove the primary lesion by ELPS combined with ESD with a negative vertical margin during a 19-day hospitalization (shown in Fig. 5c). The mucosal defect was completely covered by normal mucosa 2 months after resection (shown in Fig. 5d).
Pathologic evaluation of the resected specimen confirmed that a well-differentiated squamous cell carcinoma invaded subepithelial layer (invasion depth 10,000 mum) with negative vertical resection margins. The lateral margin was difficult to determine because of the effect of burning during resection (red arrow).
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F6
However, the final pathology diagnosis was positive because of the presence of tumor at the margins (shown in Fig. 6).
PMC9841794_04
a Intraoperative endoscopic images after tracheal intubation show a distorted protruded lesion on the posterior wall of hypopharynx. b A PET-CT shows a right internal deep cervical lymph node swelling, and there is slight FDG uptake (Yellow arrow). c The primary site, immediately after ELPS combined with ESD. The lesion is completely resected. d Two months following ELPS combined with ESD. The ulcer has completely healed without significant deformation.
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F7
Esophagogastroduodenoscopy revealed a flat elevated lesion of 25 mm in size in the posterior wall of the hypopharynx (shown in Fig. 7a). PET-CT showed right internal deep cervical lymph node swelling with FDG uptake (shown in Fig. 7b). ELPS combined with ESD and subsequent lymph node dissection was performed in one session (shown in Fig. 7c). The mucosal defect was completely covered by normal mucosa 2 months after resection (shown in Fig. 7d).