Department of Head and Neck Surgery
Ryuichi Hayashi, Masakazu Miyazaki, Takeshi Shinozaki, Toshifumi Tomioka, Takashi Maruo,Takashi Mukaigawa, Kazuki Hashimoto
Surgical treatment of head and neck cancer must meet two contradictory requirements: (1) the resection volume must be sufficiently large to remove all cancer cells, and (2) the resection volume should be sufficiently small to preserve important functions such as swallowing, speech, vision, and cosmetic appearance. The Department of Head and Neck Surgery resolves these conflicting requirements mainly by two distinct approaches: (1) conservative surgery and (2) extensive resection with microsurgical reconstruction. We have been developing various larynx-preserving operations following the establishment of the National Cancer Center. These procedures include a partial laryngectomy which is indicated for T1/ T2 recurrent glottis carcinoma after radiotherapy. Another example of conservative surgery is partial hypopharyngectomy with preservation of the larynx for hypopharyngeal carcinoma. Recently, trans-oral resection, such as ER or ELPS, for pharyngo-laryngeal cancer using an endoscope has been increasing after detection of superficial head and neck cancer. On the other hand, extensive resection with microsurgical reconstruction is designed to minimize loss of function following ablative surgery by employing the microsurgical transfer of various flaps.
The current treatment policy for head and neck cancer is multimodal therapy. To effectively implement available therapeutic modalities, four staff surgeons at the Department work closely with plastic surgeons, radiotherapists, medical oncologists, pathologists, dentists, psychooncologists, nurses, and other hospital staff. To facilitate regular communication among the members of this large team, several weekly conferences are conducted. The number of new cases who were treated in the hospital was 543 and the number of operations was 531. A total of 68 cases underwent ESD or ELPS and 97 cases underwent free flap reconstruction
Cystadenocarcinoma of the salivary glands with potential lymph node metastasis.
Cystadenocarcinoma is classified as a low-grade histological subtype of salivary gland tumors. Although the tumor has the potential to produce lymph node metastases, it is generally an indolent tumor with a good prognosis as compared with high-grade subtypes. Long-term follow-up paying close attention to lymph node metastases is necessary for cystadenocarcinoma.
Nine cases of carcinoma with neuroendocrine features in the head and neck: clinicopathological characteristics and clinical outcomes
As neuroendocrine carcinomas in the head and neck region are extremely rare, their clinicopathological characteristics remain largely unknown. Moreover, the 2005 World Health Organization classification criteria for head and neck carcinomas with neuroendocrine features have nu merous limitations. Therefore, the clinicopathological features and patient outcomes of these tumors must be clarified. Carcinomas with neuroendocrine features were found to have an aggressive clinical course, which corresponded with the Ki-67 index and mitotic count. Owing to the difficulty in appropriately diagnosing head and neck carcinomas with neuroendocrine features using the current classification system, a new classification system should be developed for use in these cases.
- Multicenter study to establish the indication of neck dissection for head and neck squamous cell carcinoma. A prospective observation study is being conducted and over 300 cases have been enrolled to this study from nine hospitals. Neck dissection at Level IIb and V areas influence the rate of postoperative accessory nerve palsy but the necessity of dissection of these areas is still controversial because of the low prevalence rate of lymph node metastasis. A randomized clinical trial will be run after evaluating the results of this study.
- Evaluation of swallowing function related to the treatment for head and neck cancer
This prospective observation study is conducted to evaluate the swallowing function after treatment for oropharyngeal cancer. This study is related to standardizing the assessment of the swallowing function.
Two senior residents and two residents were recruited to our department in 2015. One head and neck surgeon from Hong Kong visited our department for training. Our Department was assigned as one of the observation centers of the International Federation of Head and Neck Oncologic Societies (IFHNOS) fellowship program from 2014.
Trans-oral resection by using an endoscope has become a standard surgical procedure for superficial pharyngeal cancer. We are going to get authorization for insurance about endoscopic resection and are planning to develop new surgical equipment for these operations.