Protocol-based OGD Surveillance for Head and Neck Cancer Patients

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Authors (including presenting author) :
Chan DKK (1), Wong IYH (1), Wong CLY (1), Cui Y (1) Law TT (2), Chan FSY (1), Law SYK (1)
Affiliation :
(1) Department of Surgery, Queen Mary Hospital, The University of Hong Kong (2) Department of Surgery, Tung Wah Hospital
Introduction :
The phenomenon of synchronous or metachronous cancers in different parts of the upper aerodigestive tract is well documented. Exposure to common carcinogenic agents leading to field cancerization was believed to be the culprit. Up to 3.8 - 14.9% patients with head and neck cancers will develop a primary esophageal squamous cell carcinoma in their lifetime. While esophageal cancer remains a highly lethal disease especially in advanced stage, detection at early asymptomatic stage allows options of endoscopic/ organ preservation treatment with better outcome and reduced healthcare cost for this subgroup of patients. As such we have launched the service of providing regular surveillance OGD to patients with history of head and neck cancers since 2011.
Objectives :
1) To delineate the incidence of a second upper aerodigestive tract lesion in patients with history of head and neck cancers; 2) To evaluate the clinical significance of early detection of such lesions
Methodology :
All patients with cancers in the head and neck region managed in Queen Mary Hospital starting from August 2011 were included. Surveillance OGD were performed for consented patients at two years interval or at discretion of the endoscopists. All OGDs were performed by experienced upper gastrointestinal surgeons. The procedure, equipment and endoscopic adjuncts, and biopsy protocol were all standardized.
Result & Outcome :
129 patients were recruited. OGD procedure failed in 3 patients due to stricture of the pharyngeal apparatus precluding endoscope passage. 8 patients (6.3%) had screening-detected neoplastic lesions. 7 of them received appropriate treatment and remained alive. 1 out of these 8 patients refused treatment and died subsequently. 5 out of the 7 treated patients/ lesions were suitable for and underwent endoscopic treatment. Conclusion: protocol-based OGD surveillance in patients with head and neck cancers allows early detection of second primary neoplastic lesion, leading to timely and more flexible treatment options and potentially better patient outcomes.

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