Head and Neck Surgery Division

Introduction

Surgical treatment of head and neck cancer must fulfill two contradictory requirements: (1) the resection volume must be sufficiently large to remove all cancer cells; (2) the resection volume should be sufficiently small to preserve important functions such as swallowing, speech, vision, and cosmetic appearance. The Head and Neck Surgery Division resolves these conflicting requirements mainly via two distinct approaches: (1) conservative surgery and (2) extensive resection with microsurgical reconstruction. Conservative surgery has been the most successful for voice preservation. This procedure includes vertical partial laryngectomy which is indicated for T1/T2 glottic carcinoma, recurrent glottic carcinoma after radiotherapy, and early false cord carcinoma. Laryngeal preservation is also possible in early hypopharyngeal carcinoma with limited extension. On the other hand, extensive resection with microsurgical reconstruction is designed to minimize loss of function following ablative surgery by employing microsurgical transfer of various flaps (further details are available in the annual report of the Plastic Surgery Division).

Routine Activities

Multimodal therapy constitutes the core of the current treatment policies for head and neck cancer. In order to effectively implement these therapeutic modalities, 5 staff surgeons at the Division work closely with plastic surgeons, radiotherapists, medical oncologists, dentists, psycho-oncologists, nurses, and other hospital staff. Several weekly conferences are conducted to facilitate regular communication among the members of this large team.
In 2008, 459 new patients were treated. Owing to the recent advances in surgical techniques and perioperative care, the number of surgically treated high-risk patients, including elderly patients over 80 years, is currently increasing. Technically difficult operations, such as surgical resection of advanced oropharyngeal carcinoma with immediate reconstruction, are also increasingly being performed.

● M. Saikawa ●

Number of new cancer patients treated (2004-2008)
Primary Cancer Site	2004	2005	2006	2007	2008
Tongue   Oral cavity, excluding the tongue   Larynx   Nasopharynx   Oropharynx   Hypopharynx and cervical esophagus   Nasal cavity and paranasal sinuses   Thyroid gland   Major salivary glands   Others	65 72 60 18 45 80 23 61 21 21	60 57 50 15 35 63 16 46 7 24	33 58 36 13 39 64 24 35 10 16	58 55 80 13 40 87 21 41 9 10	55 44 87 24 62 83 32 36 22 14
Total	466	373	328	414	459

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