Head and Neck Surgery

Introduction

Surgical treatment for head and neck cancer demands the fulfillment of two contradictory requirements: there must be a resection large enough to eradicate all the cancer cells and small enough to preserve important functions, such as swallowing, speech, vision, and cosmetics. The Division of Head and Neck Surgery resolves 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

Multi-modal therapy is the core of current treatment policies for head and neck cancers. To conduct therapies effectively, seven 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 1999, 318 new patients were treated in this division. 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

Concurrent chemo-radiotherapy has obtained a wider indication for the treatment of head and neck cancers. Although chemo-radiotherapy had been previously indicated for inoperable cases only, it was selected for several patients with advanced but operable mesopharyngeal or hypopharyngeal cancer to preserve the voice or other important functions. Adequate protocol studies are urgently required to evaluate its safety and to compare its prognosis and functional results with those of the standard surgical treatment.

Careful evaluation of proton therapy was continued according to a nationally approved protocol.

Number of New Patients by Primary Site
	1999
Tongue	49
Oral cavity excluding the tongue	55
Larynx	37
Nasopharynx	15
Mesopharynx	33
Hypopharynx and cervical esophagus	46
Nasal cavity and paranasal sinuses	24
Thyroid gland	39
Major salivary glands	8
Others	12
Total	318

(M. SAIKAWA, R. HAYASHI)

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