Preservation of vital organ function is the goal of several surgical innovations. In particular, the central focus of many organ-preserving strategies for head and neck malignancies is the larynx. Early narrow band imaging (NBI) endoscopic detection of hypopharyngeal cancer contributes to increasing the possibility of larynx preservation. Although these surgical approaches have been extended in recent years to include advanced disease management, an adequate surgical approach is necessary for safe and reliable operations.
Supraglottic and frontolateral partial laryngectomies are 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 33/50 patients (66%; median follow–up period, 56 months) and a functional larynx was preserved in 83% of the patients who underwent partial laryngectomy. From these results, partial laryngectomy is considered as a standard procedure for treating cases of irradiation failure.
Early detection of hypopharyngeal cancers, including NBI endoscopic detection, provides a novel conservation surgery procedure for treating hypopharyngeal carcinomas. Primary closure of residual mucosal defects after tumor removal can be safely performed because of the small defects. We reviewed 38 patients who underwent primary closure of residual mucosal defects after tumor removal between 1992 and 2007. In these patients, the local control and larynx preservation rates were 84% and 78%,respectively. Severe complications were not evident. This surgical procedure is reliable for the treatment of early stage hypopharyngeal carcinoma.
This work was performed as a multicenter study. Patients who underwent resection of oral and oropharyngeal tumors between 2000 and 2002 were reviewed retrospectively. A total of 817 patients underwent the operation, of which 638 were operated for oral malignancies and the remaining 179 for oropharyngeal malignancies. On the other hand, 372 patients underwent tumor resection intraorally and 313 received the pull-though approach for tumor resection. The lower lip-splitting procedure and the mandibular-swing approach were performed in 49 and 69 patients, respectively. The mandibular-swing approach was used in only 5% of the patients for the resection of tumors in the oral cavity; however, it was employed in 20% of the patients with oropharyngeal tumors. Mandibulectomy was carried out in 84% of the patients who underwent the lower lip-splitting procedure. Moreover, 90 patients from among those who underwent the pull-though approach received mandibulectomy without lower lip-splitting. Notably, the mandibular-swing approach is sometimes useful for the removal of advanced oropharyngeal tumors, while the pull-though approach can be indicated for patients scheduled to receive madibulectomy.
A study of concurrent chemoradiotherapy for inoperable head and neck squamous cell carcinoma was started from December 2008 as a JCOG trial. There are currently several ongoing clinical trials of chemoradiotherapy for treating head and neck cancers. For further information, please refer to the reports of the Gastrointestinal Oncology and Radiation Oncology Divisions.
● R. Hayashi●
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