Video-assisted and microsurgical resection with double contrast in oropharyngeal cancer

Introduction. The incidence of oropharyngeal cancer is steadily increasing, mainly due to an increase in the number of cases of Hpv (human papillomavirus) infection. This is an important trend from a clinical point of view, since Hpv-positive oropharyngeal cancer is associated with a better prognosis and treatment results. Despite its visually accessible location, the diagnosis of oropharyngeal cancer can be challenging due to the complexity of its anatomical structure. The active development of minimally invasive transoral microsurgery, combined with fluorescent technologies, demonstrates the effectiveness of early diagnosis of oropharyngeal tumors.

Aim. To improve the diagnosis of oropharyngeal tumors, introduction into clinical practice of transoral microsurgical resections with double contrasting.

Materials and methods. In the clinic of plastic surgery of the first moscow medical university named after I.M. Sechenov, a method for early diagnosis of oropharyngeal cancer was developed. The method consisted in intraoperative sequential double contrasting of the mucous of the oropharynx with indocyanine green and methylene blue, followed by autofluorescent videopharyngoscopy, transoral microsurgical, video-assisted resection based on the use of an operating microscope and rigid end-point optics (endoscope). Eleven surgeries were performed successfully.

Results. The postoperative period was smooth and uncomplicated in all patients. According to the data presented, local recurrence was confirmed in 18 % (2 patients out of 11) after special treatment for oropharyngeal cancer using our method.

Conclusion. Modern treatment of cancer patients requires not only cure, but also careful monitoring of the disease. The use of transoral video-assisted and microsurgical resection based on double contrasting is an alternative method for early diagnosis of both primary oropharyngeal cancer and its recurrence.