Department of Head and Neck Surgery

Kazuto Matsuura, Takeshi Shinozaki, Toshifumi Tomioka, Wataru Okano, Yohei Morishita, Ryuichi Hayashi, Hiroshi Idogawa, Yusuke Itoh, Masanobu Sato, Shohei Fujimoto, Daisuke Baba, Koutarou Maeda, Yuki Takaoka

Introduction

The characteristic feature of our division for head and neck cancer treatment is the development of function-preservation surgery. Representative techniques include the following:

• Partial laryngectomy for T1/T2 recurrent glottic cancer after radiotherapy
• Laryngeal-preservation surgery for hypopharyngeal cancer
• Advanced oral and pharyngeal cancer resection without amputation of the lower lip and mandible
• Conservative neck dissection

Due to these efforts, there are many cases of laryngeal preservation surgery for laryngeal and hypopharyngeal cancer compared to other facilities. In recent years, the number of transoral resection cases using endoscopes for early-stage laryngopharyngeal cancer has increased, and minimally invasive surgery has become widespread.

The team and what we do

The current treatment policy for head and neck cancer is multimodal therapy. To effectively implement available therapeutic modalities, five staff surgeons at our department work closely with plastic surgeons, radiotherapists, medical oncologists, pathologists, dentists, psycho-oncologists, and nurses. To facilitate regular communication among the members of this large team, several weekly conferences are conducted.

From April 2021 to March 2022, the number of operations was 515 cases. 104 cases underwent endoscopic laryngo-pharyngeal surgery (ELPS), 94 cases underwent free flap reconstruction and 15 cases of endoscopic thyroid surgery were performed (Tables 1, 2). In January 2021, photoimmunotherapy started under health insurance.

Table 1. Number of patients (April 2020 to March 2021)


Table 2. Type of procedures (April 2020 to March 2021)

Research activities

(1) In terms of equipment development for endoscopic surgery for head and neck cancer, the development of forceps and hemostatic clip appliers for endoscopic surgery has progressed. A prototype of the clip applier has been completed.

(2) Using the database of head and neck cancer surgery patients created in 2019-2020, we analyzed the long-term prognosis after laryngeal-preservation surgery performed on elderly head and neck cancer patients. It was confirmed that the laryngeal function could be preserved for a long time after surgery even in the elderly.

(3) In the development of supportive care in surgery for head and neck cancer, a multicenter study on an enhanced recovery after surgery (ERAS) program for patients undergoing reconstructive surgery for head and neck cancer was launched, and the study was approved by J-SUPPORT (PreSte-HN study: J-SUPPORT2002). This study was accepted as an AMED study (study number 21ck0106674h0001) and case enrollment has begun.

Clinical trials

Based on the AMED Hayashi Group (18ck0106226h0003) "National Superficial Head and Neck Cancer Registry'', research on the development of diagnostic and therapeutic methods for superficial head and neck cancer was advanced. Enrollment for the phase III study of the TOS-J study (Principal Investigator: Ryuichi Hayashi, Phase II/III study of oral surgery for superficial head and neck cancer in Japan) has been completed. JCOG1212 (Dose-finding and confirmatory study of superselective intra-arterial cisplatin infusion and combined radiotherapy for patients with locally advanced maxillary sinus cancer) has also been completed. Enrollment is underway for JCOG1601, a randomized phase III study evaluating the value of prophylactic neck dissection omission for stage I/II tongue cancer. JCOG1912 (randomized controlled trial on dose reduction of prophylactic area irradiation in head and neck cancer chemoradiotherapy) has also been initiated.

Education

We accepted one oncologist and two residents for training. In addition, one person acquired head and neck cancer specialist certification. The visitors from Japan were three doctors. Our hospital has been a training facility for the Fellowship Program of the International Federation of Head and Neck Cancer since 2014, but in 2021 we did not accept trainees from overseas.

Future prospects

Head and neck cancer treatment has entered a new era of multidisciplinary treatment, with improvements in surgical techniques, technological innovations in radiotherapy, development of pharmacotherapy, and recognition of the importance of supportive care for the completion of treatment. In addition, the number of elderly patients with head and neck cancer is increasing, which poses a major problem in clinical practice. A system for smooth cooperation between related medical departments has been established, but in the future we would like to aim to establish a telemedicine system. In surgery, we would like to promote the development of treatments that are minimally invasive and preserve function.

List of papers published

Journal

1. Adachi M, Tomioka T, Fujii S, Morishita Y, Okano W, Shinozaki T, Matsuura K, Hayashi R. Is elective neck dissection necessary for patients with cT3-4N0 parotid gland cancer? Auris, nasus, larynx, 49:856-861, 2022

2. Imai T, Asada Y, Matsumoto K, Sato I, Goto T, Matsuura K. Neck dissection with carotid artery resection after insertion of a protective endovascular covered stent for recurrent head and neck cancer: a case report. International cancer conference journal, 11:119-123, 2022

3. Fujii K, Imai T, Asada Y, Sato I, Yamazaki T, Matsuura K. A case of cardiac metastases from head and neck cancer presenting as hyperdense armored heart. International cancer conference journal, 11:23-26, 2022

4. Morishita Y, Sakashita S, Tomioka T, Okano W, Shinozaki T, Higashino T, Matsuura K, Hayashi R. Human papillomavirus-related multiphenotypic sinonasal carcinoma. Auris, nasus, larynx, 2021

5. Katada C, Muto M, Fujii S, Yokoyama T, Yano T, Watanabe A, Iizuka T, Yoshinaga S, Tateya I, Mitani H, Shimizu Y, Takahashi A, Kamijo T, Hanaoka N, Abe M, Shiotani A, Kano K, Asada Y, Matsuhashi T, Umeno H, Okami K, Goda K, Hori S, Ono Y, Terai S, Nagami Y, Takemura K, Kawada K, Ando M, Shimeno N, Arai A, Sakamoto Y, Ichinoe M, Nemoto T, Fujita M, Watanabe H, Shimoda T, Ochiai A, Kato T, Hayashi R. Transoral surgery for superficial head and neck cancer: National Multi-Center Survey in Japan. Cancer medicine, 10:3848-3861, 2021

6. Imai T, Asada Y, Matsumoto K, Goto T, Matsuura K. Dissection of Cervical Lymph Node Metastasis With Internal Jugular-Subclavian Venous Junction Invasion Via an Approach Involving Resection of the Margin of the Medial Clavicle. Cureus, 13:e16055, 2021

7. Kishimoto aK, Kanazawa K, Nomura M, Tanaka T, Shigemoto-Kuroda T, Fukui K, Miura K, Kurosawa K, Kawai M, Kato H, Terasaki K, Sakamoto Y, Yamashita Y, Sato I, Tanuma N, Tamai K, Kitabayashi I, Matsuura K, Watanabe T, Yasuda J, Tsuji H, Shima H. Ppp6c deficiency accelerates K-ras(G12D) -induced tongue carcinogenesis. Cancer medicine, 10:4451-4464, 2021