Surgical endoscopy · 2026
Impact of pharyngeal deformity on the development of aspiration pneumonia following endoscopic submucosal dissection for superficial pharyngeal squamous cell carcinoma.
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Suzuki Yugo, Oda Minoru, Kikuchi Daisuke, Iizuka Toshiro, Ohashi Kenichi, Hoteya Shu
Аннотация
BACKGROUND: Endoscopic submucosal dissection (ESD) is widely used for superficial hypopharyngeal squamous cell carcinoma, but post-ESD pharyngeal deformity may impair swallowing. This study aimed to assess the association between deformity severity and the cumulative incidence of aspiration pneumonia and to identify clinical factors related to aspiration risk.
METHODS: This retrospective study included 228 patients with 312 lesions who underwent ESD for superficial hypopharyngeal cancer with resected specimens ≥ 30 mm. Pharyngeal deformity was graded from 0 to 3, and the piriform sinus was subdivided into three fields. Clinical characteristic, mucosal defect features, and the cumulative incidence of aspiration pneumonia were evaluated. Independent predictors of aspiration pneumonia were identified using Cox proportional hazards models.
RESULTS: Grade ≥ 2 deformity occurred in 30.4% of piriform sinus defects and was strongly associated with defect extent, occurring in 0% of one-field, 19.8% of two-field, and 83.7% of three-field defects. Aspiration pneumonia developed in 25 patients (11.0%) during a median follow-up of 58 months. The cumulative 3-, 5-, and 10-year incidence rates were 6.7%, 9.5%, and 17.0%, respectively. Multivariate analysis identified grade ≥ 2 deformity (HR 3.582; 95% CI 1.563-8.210), esophagectomy (HR 4.449; 95% CI 1.695-11.681), chemoradiotherapy (HR 2.937; 95% CI 1.271-6.783), and American Society of Anesthesiologists physical status classification ≥ III (HR 13.447; 95% CI 3.743-48.307) as independent predictors.
CONCLUSIONS: Severe post-ESD pharyngeal deformity is a key determinant of long-term aspiration pneumonia risk. The extent of the mucosal defect strongly influences deformity development, underscoring the importance of precise lesion assessment and sustained follow-up.
METHODS: This retrospective study included 228 patients with 312 lesions who underwent ESD for superficial hypopharyngeal cancer with resected specimens ≥ 30 mm. Pharyngeal deformity was graded from 0 to 3, and the piriform sinus was subdivided into three fields. Clinical characteristic, mucosal defect features, and the cumulative incidence of aspiration pneumonia were evaluated. Independent predictors of aspiration pneumonia were identified using Cox proportional hazards models.
RESULTS: Grade ≥ 2 deformity occurred in 30.4% of piriform sinus defects and was strongly associated with defect extent, occurring in 0% of one-field, 19.8% of two-field, and 83.7% of three-field defects. Aspiration pneumonia developed in 25 patients (11.0%) during a median follow-up of 58 months. The cumulative 3-, 5-, and 10-year incidence rates were 6.7%, 9.5%, and 17.0%, respectively. Multivariate analysis identified grade ≥ 2 deformity (HR 3.582; 95% CI 1.563-8.210), esophagectomy (HR 4.449; 95% CI 1.695-11.681), chemoradiotherapy (HR 2.937; 95% CI 1.271-6.783), and American Society of Anesthesiologists physical status classification ≥ III (HR 13.447; 95% CI 3.743-48.307) as independent predictors.
CONCLUSIONS: Severe post-ESD pharyngeal deformity is a key determinant of long-term aspiration pneumonia risk. The extent of the mucosal defect strongly influences deformity development, underscoring the importance of precise lesion assessment and sustained follow-up.