Department of Head and Neck Surgery

Kazuto Matsuura, Takeshi Shinozaki, Toshifumi Tomioka, Wataru Okano, Ryuichi Hayashi, Yuki Harada, Naoki Akisada, Yousuke Mizunari, Kai Kanemoto, Yoshihide Shima, Hayato Imanari, Masaya Kinjo

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 2023 to March 2024, the number of operations was 475 cases. 109 cases underwent endoscopic laryngo-pharyngeal surgery (ELPS), 90 cases underwent free flap reconstruction, 12 cases underwent photoimmunotherapy and 13 cases of endoscopic thyroid surgery were performed (Table).

Table: Number of patients (April 2023 to March 2024)

Oral cavity	155
Pharynx	148
Larynx	13
Sino-nasal Cavity	6
Thyroid	63
Salivary gland	18
Neck dissection (Only)	44
Neck dissection (Combined)	163
ELPS	109
Free flap reconstruction	90
photoimmunotherapy	12
VANS	13
TORS	10
Total	475

Research activities

1. A Multicenter Prospective Cohort Study in Patients who Undergo Transoral Surgery for Superficial Head and Neck Cancer (TOSJ2)
2. A study of prophylactic cervical lymph node dissection for Stage I/II tongue cancer by the Japan Clinical Oncology Group (JCOG1601)
3. A multicenter, nonrandomized, validated study of intensity-modulated radiation therapy (IMRT) for T1-2NO-1MO nasopharyngeal carcinoma by the Japan Clinical Oncology Group (JCOG1208)
4. Implementation of a registry project for malignant tumors of the head and neck in Japan
5. a multicenter, placebo-controlled, double-blind, randomized, phase III trial to evaluate the efficacy of preoperative steroid administration for free flap reconstructive surgery of head and neck malignancies
6. An international multicenter prospective observational study of multi-omics data for cancer research and the development of new diagnostic and therapeutic approaches
7. A retrospective study of postoperative swallowing function in patients undergoing reconstructive surgery for oral cancer
8. An observational study of the efficacy and safety of head and neck Illuminox treatment with the ACALUX and BioBlade laser systems in patients with unresectable locally advanced or locally recurrent head and neck cancer
9. A multicenter basic research study to develop personalized peptide vaccine therapy and T-cell transfer therapy for advanced oral cancer
10. Development of a real-time navigation system using AI-based image recognition technology for endoscopic thyroid surgery
11. Oxygen saturation imaging endscopy for predicting radiotherapy sensitivity in squamous cell carcinoma of the head and neck
12. Development of a technique for specular cervical dissection and study of its safety and equivalence
13. A phase II study of oral surgery for superficial local residual recurrence after radical irradiation for head and neck cancer
14. Prospective observational study to evaluate fluorescence imaging of photoimmunotherapy for head and neck cancer using a near-IR camera system
15. A multicenter observational study of oxygen saturation imaging endoscopy for treatment selection based on chemoradiotherapy sensitivity and prognostic prediction of resectable locally advanced head and neck cancer

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 currently accept seven residents for training. In 2024, five doctors from Japan have visited.. Our hospital has been a training facility for the Fellowship Program of the International Federation of Head and Neck Cancer since 2014, in 2024 we will accept three trainee 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 aim to establish a telemedicine system.. In surgery, we will promote the development of treatments that are minimally invasive and preserve function.

List of papers published

Journal

1. Yamamoto T, Shinozaki T, Nishiya Y, Okano W, Tomioka T, Matsuura K, Furuse K, Oshima A, Higashino T, Hayashi R. Early enteral nutrition and mobilization following head and neck surgery with free flap reconstruction. Jpn J Clin Oncol. 2024, 30
2. Tomizawa K, Motegi A, Oyoshi H, Fujisawa T, Zenda S, Zhou Y, Nakamura M, Hirata H, Hojo H, Kageyama SI, Hirotaki K, Matsuura K, Akimoto T. Accelerated three-dimensional conformal radiotherapy for early-stage glottic cancer in reducing dose to the internal carotid artery and pharyngeal constrictor muscles. Head Neck. 2024, 46(2)
3. Tomioka T, Beppu T, Onitsuka T, Fujimoto Y, Kawabata K, Matsuura K, Fujii T, Hayashi R, Asakage T. Post-operative progress of arm abduction function and rate of lymph node metastasis around the region of the accessory nerve: a multicentre prospective observational study. Jpn J Clin Oncol. 2023, 53(5)
4. Shinozaki T, Matsuura K, Okano W, Tomioka T, Nishiya Y, Machida M, Hayashi R. Eligibility for Photoimmunotherapy in Patients with Unresectable Advanced or Recurrent Head and Neck Cancer and Changes before and after Systemic Therapy. Cancers (Basel). 2023, 26 (15)
5. Shinozaki T, Imai T, Kobayashi K, Yoshimoto S, Zenda S, Yamaguchi T, Eguchi K, Okano T, Mashiko T, Kurosaki M, Miyaji T, Matsuura K. Preoperative steroid for enhancing patients' recovery after head and neck cancer surgery with free tissue transfer reconstruction: protocol for a phase III, placebo-controlled, randomised, double-blind study (J-SUPPORT 2022, PreSte-HN Study). BMJ Open. 2023, 13(5)
6. Sato M, Enokida T, Wada A, Okano S, Tanaka H, Fujisawa T, Ueda Y, Motegi A, Shinozaki T, Takeshita N, Tanaka N, Zenda S, Matsuura K, Akimoto T, Hayashi R, Tahara M. Potential efficacy of local therapy for progressive lesions after nivolumab in patients with recurrent or metastatic squamous cell carcinoma of the head and neck. Int J Clin Oncol. 2023, 28(8)
7. Oshima A, Wakabayashi M, Ikeno T, Matsuura K, Hayashi R, Higashino T. Second free jejunum transfer after flap loss does not affect oral intake: A retrospective case-control study. J Plast Reconstr Aesthet Surg. 2024, 88
8. Hidaka T, Miyamoto S, Furuse K, Fukunaga Y, Oshima A, Matsuura K, Higashino T. Evaluation of aesthetic outcomes of mandibular reconstruction using artificial intelligence. Head Neck. 2024, 3
9. Adachi M, Taki T, Sakamoto N, Kojima M, Hirao A, Matsuura K, Hayashi R, Tabuchi K, Ishikawa S, Ishii G, Sakashita S. Extracting interpretable features for pathologists using weakly supervised learning to predict p16 expression in oropharyngeal cancer. Sci Rep. 2024, 14(1)
10. Fujisawa T, Motegi A, Hirata H, Zenda S, Hojo H, Nakamura M, Oyoshi H, Tomizawa K, Zhou Y, Fukushi K, Kageyama SI, Enokida T, Okano S, Tahara M, Shinozaki T, Hayashi R, Matsuura K, Akimoto T.
    Long-term outcomes of patients with oral cavity cancer receiving postoperative radiotherapy after salvage neck dissection for cervical lymph node recurrence. Head Neck. 2024, 46(3)
11. Idogawa H, Shinozaki T, Okano W, Matsuura K, Hayashi R. Nasopharyngeal Carcinoma Treated With Photoimmunotherapy. Cureus. 2023, 15(11)
12. Hidaka T, Miyamoto S, Furuse K, Oshima A, Matsuura K, Higashino T. Machine learning approach to predict tracheal necrosis after total pharyngolaryngectomy. Head Neck. 2024, 46(2)
13. Homma A, Mikami M, Matsuura K, Onimaru R, Yoshida D, Shinomiya H, Ohkoshi A, Hayashi R, Saito Y, Tachibana H, Shiga K, Ueda T, Uemura H, Nakamura K, Fukuda H; Head and Neck Cancer Study Group of the Japan Clinical Oncology Group (JCOG-HNCSG). Dose-Finding and Efficacy Confirmation Trial of the Superselective Intra-arterial Infusion of Cisplatin and Concomitant Radiation Therapy for Locally Advanced Maxillary Sinus Cancer (JCOG1212): Results of the Efficacy Confirmation Phase in Patients with T4aN0M0. Int J Radiat Oncol Biol Phys. 2024,118(5)
14. Imai T, Asada Y, Matsuura K. Enhanced recovery pathways for head and neck surgery with free tissue transfer reconstruction. Auris Nasus Larynx. 2024, 51(1)
15. Kondo A, Shinozaki T, Nishiya Y, Okano W, Tomioka T, Hayashi R, Ogawa R, Matsuura K. Factors affecting polyglycolic acid sheet engraftment success for covering mucosal defects from head and neck surgery. Jpn J Clin Oncol. 2023, 53(7)
16. Adachi M, Aoyama N, Kojima M, Sakamoto N, Miyazaki S, Taki T, Watanabe R, Matsuura K, Kotani D, Kojima T, Fujita T, Tabuchi K, Ishii G, Sakashita S. The area of residual tumor predicts esophageal squamous cell carcinoma prognosis following neoadjuvant chemotherapy. J Cancer Res Clin Oncol. 2023, 149(8)