Head and Neck Surgery

Introduction
Surgical treatment for head and neck cancer demands fulfillment of two contradictory require-ments: 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 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, seven staff surgeons in 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 2002, 441 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 chemoradiotherapy has obtained wider indication for head and neck cancer. Although chemo-radiotherapy had been previously indicated to inoperable cases only, it was selected for several patients with advanced but operable mesopharyngeal, or hypopharyngeal cancer to preserve voice or other important functions. A new protocol of chemoradiotherapy is being prepared for operable cases of advanced laryngeal cancer where consent to total laryngectomy is not available.
Careful evaluation of proton therapy is ongoing according to nationally approved protocols.
Endoscopic mucosal resection (EMR) has been very successful in treatment for early esophageal and gastric cancers. In 2002, we tried EMR in several cases with early hypopharyngeal carcinoma. Because the results were promising, EMR is expected to become another choice for voice preservation therapy.

R. HAYASHI
M. SAIKAWA

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