Annual Report 2023

Department of Head and Neck Surgery

Kazuto Matsuura, Takeshi Shinozaki, Toshifumi Tomioka, Wataru Okano, Yukio Nishiya, Ryuichi Hayashi, Yusuke Ito, Hideki Tanaka, Daisuke Baba, Yuki Harada, Takuya Yamamoto, Kenya Kinjo, Hayato Imanari

Introduction

 A distinctive feature of our department is the development of function-preserving surgery. We are also actively introducing advanced surgical procedures. Typical techniques include the following:

• Larynx-sparing surgery for laryngeal and hypopharyngeal cancer
• Development of regional neck dissection in salvage surgery
• Endoscopic laryngeal surgery (ELPS)
• Endoscopically assisted thyroid surgery (VANS)
• Robotic-assisted laryngeal surgery (TORS)
• Photoimmunotherapy (PIT)

 In radical surgery for laryngeal and hypopharyngeal cancer, more patients are treated with laryngeal preservation than at other institutions. In particular, minimally invasive surgeries using endoscopes and robots are frequently performed.

 The number of cases by site and procedure is shown (with some duplicates) (Tables 1 and 2).

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. Particularly, 109 cases of endoscopic laryngo-pharyngeal surgery (ELPS), 90 cases underwent free flap reconstruction, 13 cases of endoscopic thyroid surgery and 12 cases of photoimmunotherapy were performed. We also started robot-assisted surgery and performed 10 surgeries. (Tables 1 and 2).

Research Activities

1) We worked on the development of an AI-based diagnostic imaging device.

 We proceeded to construct an automatic imaging system to improve the detection of superficial cancer of the pharynx with the pharyngeal videoscope.

 We developed a real-time navigation system using AI-based image recognition technology for endoscopic thyroid surgery.

2) A multicenter observational study was established to predict chemoradiosensitivity using oxygen saturation imaging endoscopy and to select treatment based on prognostic prediction.

3) A multicenter study of the Enhanced Recovery After Surgery (ERAS) program for reconstructive surgery for head and neck cancer (PreSte-HN study: J-SUPPORT2002) was accepted for AMED study (study number 21ck0106674h0001), and case accrual has been faster than planned.

Clinical Trials

1) Registration for the PreSte-HN study (Principal Investigator: Kazuto Matsuura, described in the previous section) is progressing smoothly.

2) Enrollment in the TOS-J2 study (Principal investigator: Ryuichi Hayashi, Phase II/III study of oral surgery for superficial head and neck cancer in Japan) is underway.

3) JCOG1601 is a randomized phase III trial evaluating the value of omitting prophylactic neck dissection for stage I/II tongue cancer, and enrollment is ongoing.

4) JCOG1912 (Randomized Controlled Trial of Dose Reduction of Prophylactic Field Radiation in Chemoradiotherapy for Head and Neck Cancer) is also ongoing.

Education

 Two new residents were accepted (total of 7), and one resident was certified as a head and neck cancer specialist. The number of domestic visitors was 8 physicians and 2 students. In 2023, we welcomed 1 resident from abroad (Georgia).

Future Prospects

 Head and neck cancer treatment has entered a new era of multidisciplinary treatment, with improvements in surgical techniques, innovations in radiotherapy, and drug therapy, as well as the recognition of the importance of supportive care for the completion of treatment. As a new approach, we are developing diagnostic methods based on endoscopic image analysis. As for surgical techniques, we intend to develop minimally invasive and function-preserving endoscopic cervical surgery.

List of papers published in 2023

Journal

1. 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. Journal of plastic, reconstructive & aesthetic surgery, 88:208-223, 2024

2. 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. 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. International journal of radiation oncology, biology, physics, 118:1271-1281, 2024

3. Homma A, Ando M, Hanai N, Harada H, Honma Y, Kanda T, Kano S, Kawakita D, Kiyota N, Kizawa Y, Nakagawa M, Ogawa T, Shinomiya H, Shinozaki T, Suzuki M, Tsuji T, Yasuda K, Zenda S, Kodaira T, Kirita T, Nibu KI. Summary of Japanese clinical practice guidelines for head and neck cancer - 2022 update edited by the Japan society for head and neck cancer. Auris, nasus, larynx, 51:174-188, 2024

4. Imai T, Asada Y, Matsuura K. Enhanced recovery pathways for head and neck surgery with free tissue transfer reconstruction. Auris, nasus, larynx, 51:38-50, 2024

5. 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, 46:239-248, 2024

6. Ariizumi Y, Hanai N, Asakage T, Seto A, Tomioka T, Miyabe J, Kessoku H, Mukaigawa T, Omura G, Teshima M, Nishikawa D, Saito Y, Asada Y, Fujisawa T, Makino T, Nishino H, Sano D, Nakahira M, Tokashiki K, Uemura H, Ueda T, Sakai A, Masuda M, Tsujikawa T, Hiei Y, Nishio N, Matsui H, Kiyota N, Homma A. Extent of thyroidectomy and paratracheal lymph node dissection in total pharyngolaryngectomy for pyriform sinus cancer, and recurrence, survival, and postoperative hypoparathyroidism: A multicenter retrospective study. Head & neck, 46:269-281, 2024

7. Hidaka T, Miyamoto S, Furuse K, Oshima A, Matsuura K, Higashino T. Machine learning approach to predict tracheal necrosis after total pharyngolaryngectomy. Head & neck, 46:408-416, 2024

8. 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, 46:541-551, 2024

9. Hiyama T, Miyasaka Y, Kuno H, Sekiya K, Sakashita S, Shinozaki T, Kobayashi T. Posttreatment Head and Neck Cancer Imaging: Anatomic Considerations Based on Cancer Subsites. Radiographics, 44:e230099, 2024

10. 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. Japanese journal of clinical oncology, hyae043, 2024

11. Tsumura R, Tomioka T, Koseki Y, Yoshinaka K. Safe Contact Force Generation for Robotic Thyroid Ultrasound Imaging. IEEE Robotics and Automation Letters, 9:1700-1707, 2024

12. 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. Japanese journal of clinical oncology, 53:401-409, 2023

13. Nakajo K, Ninomiya Y, Kondo H, Takeshita N, Uchida E, Aoyama N, Inaba A, Ikematsu H, Shinozaki T, Matsuura K, Hayashi R, Akimoto T, Yano T. Anatomical classification of pharyngeal and laryngeal endoscopic images using artificial intelligence. Head & neck, 45:1549-1557, 2023

14. Matsuzuka T, Tsukahara K, Yoshimoto S, Chikamatsu K, Shiotani A, Oze I, Murakami Y, Shinozaki T, Enoki Y, Ohba S, Kawakita D, Hanai N, Koide Y, Sawabe M, Nakata Y, Fukuda Y, Nishikawa D, Takano G, Kimura T, Oguri K, Hirakawa H, Hasegawa Y. Predictive factors for dissection-free sentinel node micrometastases in early oral squamous cell carcinoma. Scientific reports, 13:6188, 2023

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. Japanese journal of clinical oncology, 53:589-594, 2023

16. Miyasaka Y, Hiyama T, Kuno H, Shinozaki T, Sakashita S, Kobayashi T. Characteristic imaging findings in a patient with chronic expanding hematoma on the floor of the mouth. International cancer conference journal, 12:185-189, 2023

17. 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, 13:e069303, 2023

18. 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. International journal of clinical oncology, 28:1023-1032, 2023

19. Furue Y, Hori K, Tomioka T, Fujii S, Okano W, Shinozaki T, Kadota T, Yoda Y, Hayashi R, Yano T. Clinical outcome of endoscopic-assisted transoral surgery for superficial cancer of pharyngo-esophageal junction. Head & neck, 45:2098-2107, 2023

20. Shinozaki T. [IV. Supportive Care for Photoimmunotherapy]. Gan to kagaku ryoho. Cancer & chemotherapy, 50:789-793, 2023

21. 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, 15:3795, 2023

22. Tanaka H, Enokida T, Okano S, Fujisawa T, Tanaka N, Takeshita N, Onaga R, Hoshi Y, Wada A, Sato M, Ueda Y, Tahara M. Subsequent chemotherapy with paclitaxel plus cetuximab-based chemotherapy following immune checkpoint inhibitor in recurrent or metastatic squamous cell carcinoma of the head and neck. Frontiers in oncology, 13:1221352, 2023

23. Idogawa H, Shinozaki T, Okano W, Matsuura K, Hayashi R. Nasopharyngeal Carcinoma Treated With Photoimmunotherapy. Cureus, 15:e49315, 2023