Annual Report 2019

Department of Head and Neck Surgery

Seiichi Yoshimoto, Go Omura, Kenya Kobayashi, Satoko Matsumura, Atsuo Ikeda, Azusa Sakai, Akiko Ito, Kohtaro Eguchi

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.

Routine activities

 In 2019, 550 patients were newly diagnosed at our department. Table 1 shows the details of the patients. Among them, 418 patients with head and neck tumor underwent surgery under general anesthesia, including 95 patients with major ablation and free flap reconstructive surgery. Table 2 shows the number of surgical cases under general anesthesia.

Table 1. Number of patients

Table 2. Type of procedure

Research activities

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

The Team and What We Do

 The Department of Head and Neck Surgery at NCCH consists of 8 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.

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

 Trans-oral resection for superficial laryngo-pharyngeal cancer will be indicated for more patients. Robotic surgery is going to be introduced soon in Japan. Treatment strategy for HPV-related oropharyngeal cancer will be discussed after analyzing clinical data and obtaining the results of 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 in 2019

Journal

1.  Kobayashi K, Matsumoto Y, Matsumoto F, Sato T, Mori T, Tsuchida T, Omura G, Matsumura S, Ikeda A, Sakai A, Eguchi K, Yoshimoto S. A surgical approach to schwannomas originating from the esophageal branch of the recurrent laryngeal nerve: Pictorial essay. Head Neck, 41:4054-4059, 2019

2.  Kobayashi K, Yoshimoto S, Matsumoto F, Ando M, Murakami N, Omura G, Fukasawa M, Matsumoto Y, Matsumura S, Akamatsu M, Hiraoka N, Eigitsu R, Mori T. All-Exon TP53 Sequencing and Protein Phenotype Analysis Accurately Predict Clinical Outcome after Surgical Treatment of Head and Neck Squamous Cell Carcinoma. Ann Surg Oncol, 26:2294-2303, 2019

3.  Matsumoto F, Matsumura S, Mori T, Mori A, Omura G, Matsumoto Y, Fukasawa M, Kobayashi K, Yoshimoto S. Common carotid artery ligation at the proximal side before rupture in patients with ligation or occlusion of the external carotid artery at risk of carotid blowout syndrome. Jpn J Clin Oncol, 49:839-844, 2019