Head and Neck Surgery
Introduction
Surgical treatment for head and neck cancer demands fulfillment of two contradictory requirements: a resection large enough to eradicate all the cancer cells and a resection small enough to preserve important functions, such as swallowing, speech, vision, and cosmetics. 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 Plastic and Reconstructive Surgery 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, six staff surgeons in this Division consistently work with plastic surgeons, radiotherapists, medical oncologists, dentists, psycho-oncologists, nurses and other hospital staff. Several weekly conferences are held to facilitate constant communication among members of this large team.
In 1998, 304 new patients were treated in this Division; a total of 592 patients underwent surgery (514 under general anesthesia and 78 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 1998, the Division of Head and Neck Surgery started skull base surgery in cooperation with the Neurosurgery Division of the Tsukiji campus, and treated 6 patients with various diseases, including olfactory neuroblastoma, adenocarcinoma of the nasal cavity, and recurrent malignant mixed tumor of the orbita. Although very aggressive and time-consuming, skull base surgery is expected to become a powerful treatment option for otherwise uncontrollable tumors involving the skull base.
Another new treatment modality was proton therapy. Two patients started to undergo this therapy in 1998. Because of its precise build-up, proton therapy is considered very suitable for deeply located diseases, such as nasopharyngeal carcinoma and parapharyngeal node metastases, although more time is required to evaluate its safety and effectiveness.
Statistics
| General anesthesia | 514 |
| Local anesthesia | 78 |
| Total | 592 |
| Tongue | 36 |
| Oral cavity excluding the tongue | 55 |
| Larynx | 24 |
| Nasopharynx | 20 |
| Mesopharynx | 38 |
| Hypopharynx and cervical esophagus | 52 |
| Nasal cavity and paranasal sinuses | 17 |
| Thyroid gland | 31 |
| Major salivary glands | 13 |
| Others | 18 |
| Total | 304 |
(M. Saikawa, R. Hayashi)
