Head and Neck Surgery
Preservation of vital organ function is the goal of several surgical innovations. The larynx is the central focus of many organ-preserving strategies because it is amenable to a variety of function-sparing surgical options, including partial laryngectomy. These surgical approaches have been extended in recent years to include advanced disease management. Free flap reconstruction with extended laryngeal conservation surgery opens the possibility of function-preserving surgery, and free flap reconstruction has been a secure and established procedure in treatment of head and neck cancers. Early narrow band imaging (NBI) endoscopic detection of hypopharyngeal cancer also contributes to increasing the possibility of larynx preservation.
Larynx Preservation Surgery
Supraglottic and frontolateral partial laryngectomy are the function-preserving treatment options for laryngeal cancer; however, these procedures are not widely performed for salvage surgery following radiotherapy. In Japan, total laryngectomy is generally performed in patients with tumor recurrence after radical radiotherapy. In our multicentric study, partial laryngectomy was successfully performed in 40/50 patients with tumor recurrence after radiotherapy for T1/T2 glottic cancers. Laryngeal preservation was possible in 36/50 patients (72%; median follow-up period, 30 months). Although further examination is necessary, partial laryngectomy may become a standard procedure for treating cases of failure of irradiation.
Early detection of hypopharyngeal cancers, including NBI endoscopic detection, reduces surgical stress and provides a novel procedure for conservation surgery for treating hypopharyngeal carcinomas. Primary closure of the residual mucosal defects after removal of the tumor can be safely performed because the defects are small.
After introduction of EMR in 2002, 32 cases have undergone primary closure of residual mucosal defects after removal of their tumors. In these patients, the larynx preservation rate was 84%, and no severe complications were evident.
New Concepts in Palliative Surgery for Head and Neck Carcinomas
Patients with head and neck cancers require airway maintenance that is generally achieved by tracheostomy, and nutrition is provided through a gastric tube or a central vein catheter; however, these procedures markedly decrease the QOL of the patients. After total pharyngo-laryngo- esophagectomy (TPLE), the food passage is reconstructed using a jejunal free flap and a permanent tracheostomy is established. Two patients underwent non-radical TPLE with the aim of achieving the ability for oral intake without requiring tracheostomy tube placement, and both of them were satisfied with the surgical outcome. Palliative TPLE is not necessarily applicable to all non-curable cancer patients who want to maintain oral intake. However, following TPLE, QOL was markedly improved in these patients (35).
Chemoradiotherapy for Head and Neck cancers
There are several ongoing clinical trials of chemoradiotherapy for treating head and neck cancers. Gastrointestinal and radiation oncologists work in collaboration with the head and neck surgeons and are responsible for the management of patients treated with chemoradiotherapy. For further information, please refer to the chapters dealing with the Gastrointestinal Oncology and Radiation Oncology Divisions.
● R. Hayashi●
Table of Contents