Author(s)

Kenro Kawada^1*, Taro Sugimoto², Ryuhei Okada², Kazuya Yamaguchi¹, Yuudai Kawamura¹, Masafumi Okuda¹, Yuuichiro Kume¹, Andres Mora¹, Tairo Ryotokuji¹, Takuya Okada¹, Akihiro Hoshino¹, Yutaka Tokairin¹, Yasuaki Nakajima¹, Yusuke Kiyokawa², Fuminori Nomura², Yoshuke Ariizumi², Shohei Tomii³, Takashi Ito³, Takahiro Asakage², Yusuke Kinugasa¹, Tatsuyuki Kawano¹

¹Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
²Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
³Department of Human Pathology, Tokyo Medical and Dental University, Tokyo, Japan.

A 65-year-old man was admitted to our hospital following 6 months of dysphagia. At first, conventional endoscopy showed a reddish and depressed lesion in the stomach and an elevated lesion in the posterior wall of the hypopharynx. An endoscopic biopsy showed adenocarcinoma in the stomach, and squamous cell carcinoma in the hypopharynx. On the further examination, trans-nasal endoscopy with narrow band imaging (NBI) was performed. During the trumpet maneuver, a huge protruded lesion was observed and it reached to the orifice of the esophagus. Other superficial lesion located at left pyriform sinus was detected by NBI system as brownish area with brown dots. Furthermore, superficial esophageal cancer in the cervical esophagus was detected. Finally, 4 carcinomas in upper gastrointestinal tract were detected. Among them, the hypopharyngeal cancer was the most advanced (T3N0). The patient hoped to preserve his voice and swallowing function, endoscopic laryngo-pharyngeal surgery (ELPS) was performed for the hypopharyngeal cancer. Endoscopic mucosal resection (EMR) was performed for the esophageal cancer, and Endoscopic submucosal dissection (ESD) was performed for the gastric cancer. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en-bloc. The histopathological findings of hypopharyngeal cancer were squamous cell carcinoma, subeipthelial invasion, 29 × 28 × 4.2 mm. The others were diagnosed as mucosal cancers. The patient is currently alive with no recurrence at 28 months after the surgery; there is no stricture at the cervical esophagus. Endoscopic laryngopharyngeal surgery for the tumor of pharyngo-esophageal junction can provide a less invasive treatment.

Endoscopic Laryngopharyngeal Surgery, Hypopharyngeal Cancer, Multiple Primary Cancer, Trumpet Maneuver, Endoscopic Submucosal Dissection

Kawada, K. , Sugimoto, T. , Okada, R. , Yamaguchi, K. , Kawamura, Y. , Okuda, M. , Kume, Y. , Mora, A. , Ryotokuji, T. , Okada, T. , Hoshino, A. , Tokairin, Y. , Nakajima, Y. , Kiyokawa, Y. , Nomura, F. , Ariizumi, Y. , Tomii, S. , Ito, T. , Asakage, T. , Kinugasa, Y. and Kawano, T. (2018) A Case of Simultaneous Triple Primary Cancers of the Hypopharynx, Esophagus, and Stomach Which Were Dissected by Endoscopic Laryngo-Pharyngeal Surgery Combined with Endoscopic Submucosal Dissection. Open Journal of Gastroenterology, 8, 94-102. doi: 10.4236/ojgas.2018.83010.