Supplementary Material for: Endoscopic Laryngopharyngeal Surgery Combined with Endoscopic Submucosal Dissection as a Treatment Option for Superficial Hypopharyngeal Cancer with Suspected Synchronous Lymph Node Metastasis

We report 4 cases of hypopharyngeal cancer preoperatively suspected with synchronous lymph node metastases. Pathologic lymph node metastasis was confirmed in three of the four cases. All 4 cases underwent endoscopic laryngopharyngeal surgery (ELPS) combined with endoscopic submucosal dissection (ESD) and subsequent lymph node dissection as an optional treatment rather than the standard treatment. Peroral resection for primary site was selected because of the expected decline in quality of life (QoL) after radical surgery. Among 4 patients, one developed local recurrence; however, the other three remained recurrence-free and survived without any additional treatment. Furthermore, the patient who developed local recurrence had a recurrence-free survival for more than 5 years, with additional chemoradiation therapy. No disorders in speech, swallowing, or breathing was observed during the follow-up period. ELPS combined with ESD is generally indicated for laryngopharyngeal cancer without synchronous lymph node metastasis. However, this can be a treatment option for patients may wish to preserve a greater QoL after treatment. In the future, when more data on the results and long-term prognosis of this treatment are accumulated, it may be possible to discuss its validity further.

本研究报告4例术前疑似合并同步淋巴结转移的下咽癌病例。4例患者中3例经病理证实存在淋巴结转移。4例患者均接受了内镜下咽喉手术（endoscopic laryngopharyngeal surgery, ELPS）联合内镜黏膜下剥离术（endoscopic submucosal dissection, ESD），并辅以淋巴结清扫术，该方案作为可选治疗而非标准治疗方案实施。之所以选择经口切除原发灶，是考虑到根治性手术后患者生活质量（quality of life, QoL）可能出现下降。4例患者中1例出现局部复发，其余3例未出现复发，且未接受额外治疗即可存活。此外，出现局部复发的患者经追加放化疗后，无复发生存期超过5年。随访期间未观察到患者出现言语、吞咽或呼吸功能障碍。内镜下咽喉手术联合内镜黏膜下剥离术通常适用于无同步淋巴结转移的咽喉癌患者，但对于希望在治疗后保留更高生活质量的患者，该方案可作为一种治疗选择。未来，随着该治疗方案的疗效与长期预后相关数据的进一步积累，可对其有效性展开更深入的探讨。