Department of Head and Neck Surgery

Seiichi Yoshimoto, Go Omura, Toshihiko Sakai, Yoshifumi Matsumoto, Azusa Sakai, Kohtaro Eguchi, Yusuke Aihara, Takane Watanabe, Yuzo Abe

Introduction

The treatment strategy for head and neck cancer is to improve the survival rates while preserving the significant functions including speech, mastication, swallowing and cosmetic appearance. In order to achieve this strategy, our department has tried to select the best treatment modality and devise new surgical procedures based on the clinical-pathological findings and our large database of patients with head and neck cancer.

 Our department has developed and performed original surgical procedures for partial or subtotal laryngectomy for newly-diagnosed and radiation-failed laryngeal cancer, partial pharyngectomy for hypopharyngeal cancer and total glossectomy for advanced tongue cancer. These surgical approaches can be performed without sacrificing the larynx. Compared with the results of conventional surgery, there are apparently fewer wound complications. Patients can resume social activities more easily when they maintain their ability to communicate vocally.

The Team and What We Do

The Department of Head and Neck Surgery at NCCH consists of 9 head and neck surgeons. Many operations are performed under general and local anesthesia with or without microsurgical reconstructive surgery. In addition to radiotherapy, concurrent chemo-radiotherapy is performed with the Department of Radiation Oncology.

 We have many patients with extremely rare malignant diseases such as head and neck sarcoma. Hence, more collaborations are needed with many departments and medical staff.

 In 2021, 443 patients with head and neck tumor underwent surgery under general anesthesia, including 118 patients with major ablation and free flap reconstructive surgery. Table 1 shows the number of surgical cases under general anesthesia.

Research activities

We are performing translational research collaborating with the Department of Pathology, the Department of Head and Neck Medical Oncology, and research institutes.

Clinical trials

We are taking part in a JCOG (Japanese Clinical Oncology Group) study concerning intra-arterial chemoradiotherapy for maxillary sinus cancer and a phase III study about END vs watchful waiting for tongue cancer. In addition, several global clinical trials about immune checkpoint inhibitors are ongoing in our hospital.

Education

We provide plenty of educational opportunities for resident doctors, especially focusing on acquiring operative techniques. They can learn everything about perioperative management, such as physical examination, image diagnosis, informed consent, preoperative preparation and postoperative management.

Future prospects

Transoral resection for superficial laryngo-pharyngeal cancer will be indicated for more patients. Robotic surgery is going to be introduced soon in our department. Treatment strategy for HPV-related oropharyngeal cancer will be developed further after obtaining the results from ongoing clinical trials. Immune checkpoint inhibitors are used for chemo-resistant patients with recurrent or metastatic tumor. We will be able to get useful information about the response rate of these drugs for Japanese patients.

List of papers published

Journal

1. Hasegawa Y, Tsukahara K, Yoshimoto S, Miura K, Yokoyama J, Hirano S, Uemura H, Sugasawa M, Yoshizaki T, Homma A, Chikamatsu K, Suzuki M, Shiotani A, Matsuzuka T, Kohno N, Miyazaki M, Oze I, Matsuo K, Kosuda S, Yatabe Y. Neck Dissections Based on Sentinel Lymph Node Navigation Versus Elective Neck Dissections in Early Oral Cancers: A Randomized, Multicenter, and Noninferiority Trial. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 39:2025-2036, 2021

2. Shiga K, Nibu KI, Fujimoto Y, Asakage T, Homma A, Mitani H, Ogawa T, Okami K, Murono S, Hirano S, Ueda T, Hanai N, Tsukahara K, Ota I, Yoshimoto S, Shinozaki T, Iwae S, Katagiri K, Saito D, Kiyota N, Tahara M, Takahashi F, Hayashi R. Sites of invasion of cancer of the external auditory canal predicting oncologic outcomes. Head and neck, 43:3097-3105, 2021

3. Ito A, Kobayashi K, Shiotsuka M, Sato T, Omura G, Matsumoto Y, Ikeda A, Sakai A, Eguchi K, Takano T, Matsumoto F, Kobayashi O, Iwata S, Yoshimoto S. Uniform infection screening allowed safe head and neck surgery during the coronavirus disease 2019 pandemic in Japan. Japanese journal of clinical oncology, 51:400-407, 2021

4. Hirose K, Konno A, Hiratsuka J, Yoshimoto S, Kato T, Ono K, Otsuki N, Hatazawa J, Tanaka H, Takayama K, Wada H, Suzuki M, Sato M, Yamaguchi H, Seto I, Ueki Y, Iketani S, Imai S, Nakamura T, Ono T, Endo H, Azami Y, Kikuchi Y, Murakami M, Takai Y. Boron neutron capture therapy using cyclotron-based epithermal neutron source and borofalan ((10)B) for recurrent or locally advanced head and neck cancer (JHN002): An open-label phase II trial. Radiotherapy and oncology: journal of the European Society for Therapeutic Radiology and Oncology, 155:182-187, 2021

5. Sano D, Shimizu A, Tateya I, Fujiwara K, Mori T, Miyamoto S, Nishikawa D, Terada T, Yasumatsu R, Ueda T, Matsumoto F, Kishimoto Y, Maruo T, Fujimoto Y, Tsukahara K, Yoshimoto S, Nibu KI, Oridate N. Treatment outcomes of transoral robotic and non-robotic surgeries to treat oropharyngeal, hypopharyngeal, and supraglottic squamous cell carcinoma: A multi-center retrospective observational study in Japan. Auris, nasus, larynx, 48:502-510, 2021

6. Eguchi K, Kobayashi K, Takano T, Ito A, Sakai A, Ikeda A, Matsumoto Y, Omura G, Matsumoto F, Yoshimoto S. Carotid artery ligation via sternotomy as a palliative surgery: Case report of advanced intramediastinal malignant soft tissue tumor. Clinical case reports, 9:2021

7. Matsumoto F, Miyakita Y, Sakai A, Akamatsu M, Matsumoto Y, Matsumura S, Omura G, Kobayashi K, Narita Y, Yoshimoto S. Resection of carcinoma of the external auditory canal in a patient with a high jugular bulb using temporal craniotomy. Auris, nasus, larynx, 48:535-538, 2021

8. Shiga K, Nibu KI, Fujimoto Y, Asakage T, Homma A, Mitani H, Ogawa T, Okami K, Murono S, Hirano S, Ueda T, Hanai N, Tsukahara K, Ota I, Yoshimoto S, Shinozaki T, Iwae S, Katagiri K, Saito D, Kiyota N, Tahara M, Takahashi F, Hayashi R. Multi-institutional Survey of Squamous Cell Carcinoma of the External Auditory Canal in Japan. The Laryngoscope, 131:E870-E874, 2021