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A Multivariate Analysis

Tam-Lin Chow, FRCS(Edin), FHKAM(Surgery); Daniel Tai-Yam Lee, FRCS(Edin), FHKAM(Surgery); Chi-Yee Choi, FRCS(Edin), FHKAM(Surgery); Tony Tung-Fei Chan, FRCS(Edin), FHKAM(Surgery); Siu-Ho Lam, FRCS(Glas), FHKAM(Surgery)

Arch Otolaryngol Head Neck Surg. 2009;135(9):882-885.

Objective  To evaluate the frequency of concomitant esophageal lesions detected by esophagoscopy in squamous cell carcinoma (SCC) in the head and neck (HNSCC) and to identify the risk factors.

Design  Retrospective medical record analysis.

Setting  Regional hospital.

Patients  From March 2000 to March 2006, 118 patients with HNSCC had undergone esophagoscopy as part of the disease workup. Three patients had double head and neck primary tumors. Sixty-five patients also underwent chromoendoscopy with Lugol's iodine solution.

Main Outcome Measures  The incidence of simultaneous esophageal cancer diagnosed on esophagoscopy. Additional esophageal lesions of clinical significance discovered during chromoendoscopy were also evaluated.

Results  Clinically important esophageal lesions were found in 12 patients (10%)—9 carcinomas and 3 dysplastic lesions. Chromoendoscopy was useful in 5 of these 12 cases, detecting 3 dysplastic lesions not visualized by ordinary esophagogastroduodenoscopy and additional lesions in 2 patients with esophageal carcinoma. Of the patients in whom isolated oral cavity SCC was considered, the incidence of synchronous esophageal lesions was only 1.5%. Sex (P = .02), younger age (P = .04), alcohol drinking (P = .047), and tumor sites (P = .002) were significant predictors of synchronous esophageal lesions on univariate analysis. On multivariate analysis, only tumor site remained a significant risk factor (P = .009).

Conclusions  Clinically important esophageal lesions rarely coexists with oral cavity SCC, for which the benefit of routine esophagogastroduodenoscopy is questionable. Chromoendoscopy enhances the identification of early but clinically important esophageal abnormalities if esophagoscopy is performed for SCC in the larynx, hypopharynx, and oropharynx.

Author Affiliations: Departments of Surgery, United Christian Hospital (Drs Chow, Choi, and Lam) and Baptist Hospital of Hong Kong (Dr Lee), Hong Kong. Dr Chan is in private practice in Hong Kong.

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