Head & Neck Surgery

Introduction
Surgical treatment for head and neck cancer demands fulfillment of two contradictory requirements: a resection that is large enough to eradicate all the tumor cells but which is small enough to preserve important functions such as swallowing, speech, vision, and appearance. The Division of Head and Neck Surgery is resolving these conflicting requirements mainly through two distinct approaches: conservation surgery and wide resection with microsurgical reconstruction. Conservation surgery has been most successful in voice preservation; vertical partial laryngectomy is indicated for T1/T2 glottic carcinoma, recurrent glottic carcinoma after radiotherapy and some cases of early false cord carcinoma. Laryngeal preservation is also possible in T1/T2 hypopharyngeal carcinoma with limited extension. Another approach, wide resection with microsurgical reconstruction, is designed to minimize functional derangements after ablative surgery by microsurgical transfer of various flaps. Please consult the ﾒPlastic Surgeryﾓ section of this annual report for further details.

Routine Activities
Multimodal therapy is the central core of current treatment policies for head and neck cancer. To conduct therapies effectively, five staff surgeons of this division consistently work with plastic surgeons, radiotherapists, medical oncologists, dentists, psycho-oncologists, nurses and other staff of this hospital. Several weekly conferences are held to facilitate constant communication among members of this large team.
In 1997, 394 new patients were treated in this division; a total of 485 patients underwent surgery, 419 under general anesthesia and 66 under local anesthesia. Thanks to recent advances in surgical techniques and perioperative care, the number of surgical treatments for high-risk patients, including elderly patients over 80, is increasing. Technically difficult operations, such as surgical resection of advanced mesopharyngeal carcinoma with immediate reconstruction, are also increasing in number.

New Developments
In 1997, two patients underwent wide resection and immediate reconstruction for advanced maxillary sinus carcinoma. This type of immediate reconstruction had been tried and abandoned 10 years before because of it complexity; it requires simultaneous transfer of the bony structures and multiple skin paddles. However, the highly refined current microsurgical reconstruction techniques changed this extremely complicated operation into a reliable procedure with acceptable postoperative function. An increased number of cases are expected to undergo this reconstruction next year.
A multiinstitutional phase I-II study of a combination chemotherapy, 254S+5FU, is ongoing for advanced or recurrent squamous cell carcinoma of the head and neck.

Statistics

Patients Admitted by Primary Site in 1997
Primary site No.

Tongue 99

Oral cavity excluding the tongue 54

Larynx 61

Nasopharynx 19

Mesopharynx 42

Hypopharynx and cervical esophagus 65

Nasal cavity and paranasal sinuses 40

Thyroid gland 53

Major salivary glands 17

Others 76

Total 526

Number of Operations in 1997

cases

General anesthesia 419

Local anesthesia 66

Total 485

Patients Admitted by Primary Site in 1997
Primary site	No.
Tongue	99
Oral cavity excluding the tongue	54
Larynx	61
Nasopharynx	19
Mesopharynx	42
Hypopharynx and cervical esophagus	65
Nasal cavity and paranasal sinuses	40
Thyroid gland	53
Major salivary glands	17
Others	76
Total	526

Number of Operations in 1997
	cases
General anesthesia	419
Local anesthesia	66
Total	485

(M. Saikawa, R. Hayashi)

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