Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: This study aimed to evaluate the prognostic outcome for adolescent and young adult (AYA) generation patients with tongue squamous cell carcinoma (TSCC). METHODS: Data were obtained from the Head and Neck Cancer Registry of Japan, and patients who were newly diagnosed with TSCC from 2011 to 2014 were extracted. We compared the clinical parameter and survival of the ≤ 39 years old (AYA) patient group with the 40-79 (non-AYA) group. Propensity score matching (PSM) was used for survival analyses. RESULTS: Our cohort included 2221 patients with TSCC. AYA and non-AYA groups consisted of 258 and 1963 patients, respectively. The AYA group has a larger proportion of females than the non-AYA group (P < 0.001). Following PSM, both overall and disease-specific survival of the AYA group was significantly longer than those of the non-AYA group (P = 0.009 and P = 0.04, respectively). CONCLUSION: We demonstrated the survival superiority of AYA patients with TSCC compared to older adult patients. Therefore, our study results may reduce this anxiety by providing patients with appropriate information of prognosis for AYA patients with TSCC.

DOI： 10.1007/s10147-022-02279-6

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OBJECTIVE: Basal information of head and neck small-cell carcinoma (HNSmCC) including epidemiology, primary site, treatment, and prognosis remains sparse due to its rarity. We report here a multicenter retrospective study on the diagnosis, treatment, and outcomes of patients with HNSmCC. MATERIALS AND METHODS: This study involved 47 patients with HNSmCC from 10 participating institutions. Eight patients were excluded for whom no pathological specimens were available (n = 2) and for discrepant central pathological judgements (n = 6). The remaining 39 patients were processed for data analysis. RESULTS: As pretreatment examinations, computed tomography (CT) was performed for the brain (n = 8), neck (n = 39), and chest (n = 32), magnetic resonance imaging (MRI) for the brain (n = 4) and neck (n = 23), positron emission tomography-CT (PET-CT) in 23 patients, bone scintigraphy in 4, neck ultrasonography in 9, and tumor markers in 25. Primary sites were oral cavity (n = 1), nasal cavity/paranasal sinuses (n = 16), nasopharynx (n = 2), oropharynx (n = 4), hypopharynx (n = 2), larynx (n = 6), salivary gland (n = 3), thyroid (n = 2), and others (n = 3). Stages were II/III/IV-A/IV-B/IV-C/Not determined = 3/5/16/6/5/4; stage IV comprised 69%. No patient had brain metastases. First-line treatments were divided into 3 groups: the chemoradiotherapy (CRT) group (n = 27), non-CRT group (n = 8), and best supportive care group (n = 4). The CRT group included concurrent CRT (CCRT) (n = 17), chemotherapy (Chemo) followed by radiotherapy (RT) (n = 5), and surgery (Surg) followed by CCRT (n = 5). The non-CRT group included Surg followed by RT (n = 2), Surg followed by Chemo (n = 1), RT alone (n = 2), and Chemo alone (n = 3). The 1-year/2-year overall survival (OS) of all 39 patients was 65.3/53.3%. The 1-year OS of the CRT group (77.6%) was significantly better compared with the non-CRT group (31.3%). There were no significant differences in adverse events between the CCRT group (n = 22) and the Chemo without concurrent RT group (n = 9). CONCLUSION: Neck and chest CT, neck MRI, and PET-CT would be necessary and sufficient examinations in the diagnostic set up for HNSmCC. CCRT may be recommended as the first-line treatment. The 1-year/2-year OS was 65.3%/53.3%. This study would provide basal data for a proposing the diagnostic and treatment algorithms for HNSmCC.

DOI： 10.3389/fsurg.2022.1049116

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BACKGROUND: Adenoid cystic carcinoma of the trachea (ACCT) is a rare cancer; ACCT with thyroid invasion is particularly rare. We first suspected anaplastic thyroid carcinoma (ATC) but diagnosed ACC after performing fine needle aspiration cytology (FNAC). A tracheal origin was confirmed after operation. CASE DESCRIPTION: We report the case of a 77-year-old female presenting to our hospital with acute inspiratory dyspnea requiring emergency tracheotomy. Physical examination revealed a right anterior neck swelling with a hard and unmovable mass. Computed tomography (CT) and ultrasonography (US) showed tumor extension to the right thyroid lobe, and between the first and third tracheal rings, which caused severe stenosis of the lumen. Next, we performed FNAC. Clinical findings were highly suspicious for ACCT with thyroid invasion. Thirty-five days after the first visit to our department, the patient underwent total laryngectomy, cervical esophagectomy, and thyroidectomy with bilateral selective neck dissections at another hospital. The tumor was located in the right posterior wall of the trachea, with extension into the right thyroid gland. Pathological examination showed an infiltrative carcinomatous proliferation with tubular and cribriform patterns. The tumor was classified as pT4N1. A definite diagnosis was made after histopathological analyis of the surgical specimen confirmed ACCT. The tumor was found to be positive for FABP7, a putative prognostic marker of ACC, and metastasized to the lungs 3 years after the surgery. CONCLUSIONS: ACCT with thyroid invasion is an extremely rare malignant neoplasm. FNAC was useful for differentiating ACCT from other diagnoses and enabled appropriate surgical treatment.

DOI： 10.1272/jnms.JNMS.2022_89-207

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J04195&link_issn=&doc_id=20210120490004&doc_link_id=10.5981%2Fjjhnc.46.334&url=https%3A%2F%2Fdoi.org%2F10.5981%2Fjjhnc.46.334&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Although the American Joint Committee on Cancer TNM classification has been amended to include human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) as an independent entity, to the authors' knowledge the optimized de-escalating treatment modality has not been established to date. METHODS: The authors conducted a retrospective, nationwide, observational study in patients with HPV-related OPSCC who were treated from 2011 to 2014 in Japan to determine the best treatment modality. RESULTS: A total of 688 patients who were newly diagnosed with HPV-related OPSCC who were treated with curative intent at 35 institutions and had coherent clinical information and follow-up data available were included in the current study. In patients with T1-T2N0 disease (79 patients), both the 3-year recurrence-free survival and overall survival (OS) rates were 100% in the group treated with radiotherapy (RT) as well as the group receiving concurrent chemoradiotherapy (CCRT). The 3-year OS rates were 94.4% (for patients with T1N0 disease) and 92.9% (for patients with T2N0 disease) among the patients treated with upfront surgery. In patients with stage I to stage II HPV-related OPSCC, the 5-year recurrence-free survival and OS rates were 91.4% and 92%, respectively, in the patients treated with CCRT with relatively high-dose cisplatin (≥160 mg/m2 ; 114 patients) and 74.3% and 69.5%, respectively, in the patients treated with low-dose cisplatin (<160 mg/m2 ; 17 patients). CONCLUSIONS: Despite it being a retrospective observational trial with a lack of information regarding toxicity and morbidity, the results of the current study demonstrated that patients with T1-T2N0 HPV-related OPSCC could be treated with RT alone because of the equivalent outcomes of RT and CCRT, and patients with stage I to stage II HPV-related OPSCC other than those with T1-T2N0 disease could be treated with CCRT with cisplatin at a dose of ≥160 mg/m2 .

DOI： 10.1002/cncr.33062

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Language：English  

This case report describes a recent case where a patient with hypopharyngeal cancer underwent resection and reconstruction with a free jejunum flap and the surgeons found a rare variation in the branching pattern of the common carotid artery. Specifically, the left facial artery arose directly from the common carotid artery, whereas the left superior thyroid artery arose from the facial artery. This branching pattern has not been reported previously. Although this is a hitherto unique case, head and neck and reconstructive surgeons should be aware of the possibility that this branching pattern may be present because it could complicate the outcomes of both neck dissection and reconstruction by free tissue transfer.

DOI： 10.1097/GOX.0000000000002305

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1177/1066896918791031

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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DOI： 10.1007/s12328-018-0867-z

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Language：Japanese   Publisher：克誠堂出版(株)  

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Language：Japanese   Publisher：克誠堂出版(株)  

再建を伴う食道切除術において胸鎖骨切除を要した頭頸部悪性腫瘍7例(男性5例、女性2例、平均年齢65.6歳)の治療成績について検討した。胸鎖骨切除の理由は腫瘍切除と縦隔気管孔造設に伴う計画的胸鎖骨切除が3例、術後合併症に対する救済手術が3例、術中合併症の止血目的が1例であり、胸鎖骨切除に起因する合併症は認めなかった。術後経口摂取が可能となった症例は6例で、食事再開は術後10日から22日であり、手術によって食事摂取を含むQOLは著明に改善した。予後は計画的胸鎖骨切除3例中2例が担癌生存、1例が無病生存で、救済手術3例中2例が担癌生存であり、死亡は2例であった。本術式は難易度が高いが、広範囲切除完遂の一助となり、生命予後と術後QOLが良好な症例も認められた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00398&link_issn=&doc_id=20180727150007&doc_link_id=%2Fad3ksgke%2F2018%2F006108%2F013%2F1008-1014%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fad3ksgke%2F2018%2F006108%2F013%2F1008-1014%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Language：Japanese   Publisher：(株)医学書院  

76歳女。2年前に腹部大動脈瘤を指摘され経過観察中であった。初診3ヵ月前に右耳前部腫瘤を自覚し、頸部CTでは軸位断で右耳前部に浅側頭動脈の走行に一致した腫瘤を認め、動脈と同等で、均一に造影された。冠状断では輸入血管を確認できた。以上の所見と局所所見を合わせて右浅側頭動脈瘤と診断し、初診5ヵ月後に全身麻酔下に摘出術を施行した。術中所見では瘤は暗赤色で、心拍と一致した拍動を認めた。近・遠位側の浅側頭動脈を同定した上で瘤の周囲を切離し、動脈を近位側と遠位側で結紮・切断して瘤を摘出した。病理組織学的所見では血管内膜には不規則な線維性の肥厚を著明に認め、肥厚部の中膜弾性板には断裂・変性等を認め、一部では中膜弾性板が消失していた。以上より、動脈硬化性変化による真性動脈瘤と診断した。併存疾患から全身の動脈硬化が示唆されたことも含めて、非外傷性動脈硬化性浅側頭動脈瘤と診断した。

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

DOI： 10.5106/jjshns.26.363

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

DOI： 10.5106/jjshns.25.415

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

DOI： 10.5106/jjshns.25.409

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1272/jnms.83.177

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科学会  

DOI： 10.3950/jibiinkoka.118.1053

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

DOI： 10.5631/jibirin.108.92

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DOI： 10.1272/jnms.82.14

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

DOI： 10.5106/jjshns.23.255

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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DOI： 10.1186/1471-2334-13-398

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(株)全日本病院出版会  

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DOI： 10.1016/j.anl.2011.08.003

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DOI： 10.1111/j.1346-8138.2010.01103.x

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1272/jnms.78.261

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Language：Japanese   Publisher：(株)篠原出版新社  

頭頸部癌診療におけるセカンドオピニオンの現状と課題について検討した。頭頸部癌患者で、セカンドオピニオンを求め紹介した57例と紹介された43例を対象とした。紹介先はがん専門病院が31例、他大学病院が10例、総合病院が10例であった。また、ホスピスへの紹介が6例であった。ホスピスへ紹介した症例を除いた51例の中で、治療方針が決定できた症例は50例であった。紹介元はがん専門病院が18例、他大学病院が14例、総合病院が11例であった。41例はセカンドオピニオン後に治療方針を決定することができた。相談内容別は、癌診断の正確性についての相談が5例、治療方法の妥当性を他の治療法と比較した相談が85例、治療の可否についての相談が10例であった。癌治療後のQOL低下についての相談が多くを占めた。

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

DOI： 10.5631/jibirin.104.341

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Language：Japanese   Publisher：(NPO)日本気管食道科学会  

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

DOI： 10.5981/jjhnc.36.417

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Language：Japanese   Publisher：日本医科大学医学会  

DOI： 10.1272/manms.6.167

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Language：Japanese   Publisher：日本医科大学医学会  

DOI： 10.1272/manms.6.101

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Language：Japanese   Publisher：日本医科大学医学会  

DOI： 10.1272/manms.6.61

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

DOI： 10.5981/jjhnc.36.101

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Language：Japanese   Publisher：(株)インターメルク  

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(株)医学書院  

顎下腺腫瘍症例において、病歴、触診所見、穿刺吸引細胞診(FNA)、画像検査結果を踏まえた総合的な判断の妥当性を検討した。対象は一次治療として手術を行った原発性顎下腺腫瘍44症例で、摘出腫瘍の組織型は良性腫瘍:37例、悪性腫瘍:7例であった。FNAと病理診断との一致率は81.8%で、良性腫瘍は86.4%(32例)、悪性腫瘍は57.1%(4例)が一致した。FNAで判定不能であったのは2例で、悪性・良性の鑑別は95.5%で可能であった。また、顎下部郭清術を行った場合、行わなかった場合と比べ、顔面神経下顎辺縁枝麻痺が多く生じることが明らかになった。FNAの信頼性は高く、FNAをより重視した術前診断で術式選択を行えば、手術を行う領域の狭小化、顔面神経下顎辺縁枝麻痺などの合併症回避が可能と考えられた。

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(NPO)日本気管食道科学会  

DOI： 10.2468/jbes.59.120

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Language：Japanese   Publisher：(株)医学書院  

耳下腺深葉良性腫瘍手術後の顔面神経麻痺について検討した。対象は、2004〜2006年までの3年間に初回手術を行った耳下腺深葉良性腫瘍21例(男性12例、女性9例・平均年齢54.8歳)で、病理診断は多形腺腫13例、ワルチン腫瘍4例、基底細胞腺腫2例、筋上皮腫2例、対照として同時期に初回手術を行った耳下腺浅葉腫瘍75例(男性40例、女性35例・平均年齢54.8歳)と比較した。顔面神経麻痺発症率は、深葉腫瘍では33.3%(7/21:全枝麻痺3例、下顎辺縁枝麻痺3例、頬骨枝麻痺1例)、浅葉腫瘍では6.7%(5/75:全枝麻痺2例、下顎辺縁枝麻痺3例)と有意差を認めた。腫瘍径別の発症率は、腫瘍径40mm以上10例中5例(50%)、39mm以下11例中2例(18%)と有意差はなく、顔面神経麻痺発症群と非発症群との間で最大腫瘍径、発生部位別発症率に有意差はなかった。深葉腫瘍で顔面神経麻痺が6ヵ月以上残存したのは7例中1例であり、不全麻痺が残存した。他の6例は全例6ヵ月以内に治癒していた。

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Language：Japanese   Publisher：日本医科大学医学会  

DOI： 10.1272/manms.4.32

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

DOI： 10.5981/jjhnc.33.499

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

DOI： 10.5981/jjhnc.33.375

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

DOI： 10.5106/jjshns.17.47

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

DOI： 10.5981/jjhnc.32.515

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

著者らが下咽頭喉頭全摘出術,両側頸部郭清術を行った下咽頭癌63例を解析し,副甲状腺機能温存について検討した.その結果,副甲状腺機能温存術式は40例で行い,うち29例(46%)で機能温存が可能であった.温存術式を困難にする要因は,原発巣の両側への進展,術前気管切開や根治的放射線治療による癒着であり,機能温存のためには上甲状腺静脈の温存が重要であることが示唆された

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

33歳女.約4ヵ月前から仰臥位になると呼吸苦を自覚していた.妊娠15週時に強く咳き込んだ際,腫瘍片を喀出したため受診した.腫瘍片は1cm大で,赤褐色の被膜に覆われており,病理診断は扁平上皮癌であった.喉頭ファイバースコピーでは声門下後壁に1cm弱の隆起性腫瘤を認め,MRIでは輪状軟骨弓レベルで膜様部から前方へ突出する腫瘤を認めた.声門下癌(扁平上皮癌:T1N0)の診断で妊娠22週に喉頭截開術を行い,周囲正常組織を5mm程含めて膜様部全層を切除した.病理所見では,分化度の低い扁平上皮細胞の中に明るい胞体を含んだ腺管構造が散見された.アルシャンブルー・パス染色では腺管内に陽性所見を呈する粘液を認め,粘表皮癌と診断した.術後経過は良好で,妊娠41週で出産し,術後2年5ヵ月現在,再発は認められず,児の発育も良好である

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Language：Japanese   Publisher：JAPAN SOCIETY FOR HEAD AND NECK SURGERY  

頸部腫瘤の基本手術である頸部郭清術の手術術式について述べた。内頸静脈を保存する郭清術について概説し,より保存的な郭清を行う際の手技について詳述した。メスや剪刀で鋭的に剥離・切開する操作のコツを示し,郭清の限界設定の仕方,内・外頸静脈や浅頸動脈の保存,副神経の追跡あるいは頸動脈鞘の扱い,さらに胸鎖乳突筋を保存した郭清術におけるポイントを解説した。手術の基本手技習得に当たって注意すべき点を述べた。

DOI： 10.5106/jjshns.15.45

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Other Link： http://search.jamas.or.jp/link/ui/2005230352

Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

頭頸部癌手術の既往のある症例で,再手術を行った際に遊離組織移植による頭頸部再建を行い,既頸部郭清術野での血管吻合を行った16症例を対象に,遊離組織移植の有用性と留意点について考察した.遊離組織移植を行った症例の局所創傷治癒は良好であり,有茎皮弁よりも有用と考えられた.移植床血管としては,頸横動脈と内頸静脈を多用していた.頸横静脈では,先行手術でその周囲を郭清していたとしても,郭清が丁寧に行われていれば,剥離が比較的容易と思われた.術野の炎症による空腸壊死例や,炎症が軽度な症例で良好な結果が得られたことから,術野の消炎の重要性が示唆された.十分に消炎される前に手術を余儀なくされる場合には,炎症野での血管吻合が回避できる炎症が有茎皮弁を第一選択とすべきであると考えられた

DOI： 10.5106/jjshns.15.55

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

66歳男.左頸部腫瘤を主訴とした.頸部CTで左頸部に広範に多発するリンパ節を認め,咽頭後リンパ節腫脹を両側に,粗大な石灰化を伴う径20mmの腫瘤を甲状腺左葉背側に認めた.穿刺吸引細胞診で甲状腺乳頭癌と診断し,甲状腺切除術を施行した.左はレベルII〜VIの郭清を施行し,胸鎖乳突筋と内頸静脈も切除したが,副神経は温存した.左反回神経は気管傍リンパ節に癒着していたため,切断した.原発巣は甲状腺左葉上極に限局しており,右葉は温存した.咽頭後リンパ節郭清に際して,左側は顎下腺を上前方に翻転し,内頸動脈を外側に翻転することで十分な視野が得られ,右側は顎下部の皮膚切開から内頸動脈を外側に翻転して副咽頭腔を展開した.咽頭後リンパ節と周囲組織の癒着は少なく,頸部からのアプローチのみで郭清は可能であった.病理所見で腫瘍の大部分は高分化型乳頭癌で,一部に低分化な部分を認め,被膜外浸潤,脈管浸潤も認めた.術後経過良好で,10ヵ月後も再発はない

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DOI： 10.1272/jnms.71.301

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

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Language：Japanese   Publisher：(株)医学書院  

70歳女.右頸部の腫瘤を主訴とした.頸胸部CT,MRIにて,右頸部から上縦隔にかけて存在する内部が一部不均一な腫瘍を認めた.頸縦隔型脂肪腫が疑われ脂肪肉腫と鑑別するため生検を行ったが脂肪肉腫と断定することはできず,脂肪腫と診断した.大きな腫瘍であり,軽度ながら異型脂肪細胞を認めたことから摘出手術を勧めたが,患者が拒否したため経過観察とした.1年後の頸胸部CT,MRIにて腫瘤は明らかに増大し,内容がより不均一となっており上縦隔へ嵌入する部分が増大し,気管は強く圧排され大きく左側に偏位していた.肉腫を疑い,腫瘍摘出術を施行し,病理診断にて高分化型の脂肪肉腫と診断した.術後経過は良好で,現在まで再発の徴候はない.検索し得た限り頸縦隔型脂肪腫の報告例は国内外合わせて5例のみであり,本症例は6例目の報告例であった

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Language：Japanese   Publisher：(株)全日本病院出版会  

頭頸部癌の診療において,患者自身が満足して治療に望むことを可能にし,後悔のないようするためには,自己決定権を尊重することが最も重要であると考え,正確な病名の告知,偏りのない,複数の治療法の説明,転院希望の有無の確認を実践している.病名告知を行うか否かは,ほぼ解決した様に思われるが,告知後の精神的ケアは未だ不十分である.又,再発症例や終末期症例,治療拒否症例や転院希望症例においては,高度なインフォームドコンセントが必要であり,心理的負担,心因性疾患への配慮がより重要になってくる.その問題解決の第一歩として,耳鼻咽喉科医,頭頸部腫瘍治療医も,今まで以上に頭頸部癌患者の心因性疾患について注目すべきである

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

DOI： 10.5981/jjhnc1974.27.62

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

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Language：Japanese   Publisher：(株)医学書院  

58歳男,63歳男,遊離空腸の適度な薄さとしなやかさの為に複雑な形態の再建が容易であり,良好な術後機能が得られた.血管柄の短さ,腸液の過分泌や接触による出血が問題になる可能性が考えられた.複数の欠損を一つの再建材料で再建したい場合,開腹手術が不可避な場合では特に有用な方法と思われた

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Language：Japanese   Publisher：(株)医学書院  

1)1992〜1998年までの7年間に当院を受診した頭頸部悪性腫瘍患者536例中,他院での根治治療を希望した症例は22例. 2)転院症例は絶対数,頭頸部悪性腫瘍患者総数に占める割合共に徐々に増加していた. 3)病名告知をすることで転院した症例が10例,当科で不可能な治療を希望して転院した症例が5例.診療に対する不満から転院した症例は7例. 4)真のインフォームドコンセントの実践のためには, 1)病名告知, 2)複数の治療法を提示した詳細な説明, 3)転院希望の確認を行うことで,自己決定権を尊重することが重要である

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(株)医学書院  

耳下腺上皮性腫瘍138例について検討した. 1)組織型の分布では,特に粘表皮癌の頻度が高いのが特徴であった. 2)20歳未満の4症例のうち悪性腫瘍が3例を占めた. 3)初診迄の期間は,良性,悪性を問わず平均約3年であった. 4)自覚的に「急に増大した」と訴えた5例は全例悪性腫瘍であった. 5)腫瘍の硬さは,組織型を反映していた

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/00016489850183575

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Language：English   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

During the 15 years period from 1978 to 1992, 417 fresh cases of tongue squamous cell carcinoma were treated in the head and neck department of Cancer Institute Hospial.<br>In tongue cancer therapy, we often treat the primary lesion and the neck metastasis separately. In such cases, non-treated area around the suprahyoid muscles (submucosal area of the oral floor) exists. Recurrence from this area in our series are 6 cases (1.4%).<br>Group I (the primary lesions and the neck metastasis were treated separately) are 140 cases, and Group II (en bloc operation) are 120 cases. 5 cases are Group I, and 1 is Group II. In each case, suprahyoid muscles are preserved. 5 of 6 cases were lost in spite of our therapy. The risk f acter of this poor prognostic recurrence can not be determined.

DOI： 10.5981/jjhnc1974.22.83

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Language：Japanese   Publisher：The Japan Broncho-esophagological Society  

From 1989 to 1991, MRI was performed in 29 patients with hypopharyngeal and cervical esophageal carcinoma at Cancer Institute Hospital. We assessed the value of MRI in these lesions compared with CT and fluoroscopy, and MRI was found to be useful to evaluate the following points: 1) upper skip lesions, 2) lower limits, 3) invasion to the prevertebral lesions, 4) invasion to the larynx, 5) metastasis to the paratracheal spaces and upper mediastinal lymphnodes, and 6) metastasis to the Rouviere's lymphnodes. MRI was especially useful when patients could not undergo the fluoroscopy because of severe aspiration or dyspnea, and when direct esophagoscopy could not be performed because of severe obstruction of the cervical esophagus.

DOI： 10.2468/jbes.43.500

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Language：Japanese   Publisher：耳鼻と臨床会  

11年間の頭頸部管腔癌患者1162例について観察人年法を用いて第2癌の発生を検討し, 相対危険度を解析した. 舌癌, 口腔癌, 下咽頭癌, 喉頭癌症例での第2癌発生は一般人口のそれより高率で認められた. 第2癌の臓器相関性は男性舌癌, 口腔癌, 下咽頭癌, 喉頭癌に対する口腔・咽頭および食道に認められた. さらに男性舌癌と下咽頭癌で胃癌, 喉頭癌で肺癌に相関性が認められた. しかし女性舌癌では口腔・咽頭のみに相関性が認められたに過ぎなかつた. 初発臓器によつては第2癌の発生間隔にも有意差が生じる可能性があつた. 症例数の少ない部位や女性症例の充分な検討はさらに多くの症例で解析する必要があると思われた.

DOI： 10.11334/jibi1954.37.5Supplement7_1311

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

From 1984 to 1989, 93 patients underwent free jejunal autograft reconstruction for lesions of the head and neck, at Cancer Institute Hospital, Japan. Eighty-four of these patients underwent pharyngoesophageal reconstruction.<br>A total of six patients experienced initial failure of the vascular anastomosis.<br>Three of these vascular complications were, however, recognized early and corrected, saving the jejunal graft. Therefore, the overall success rate for microvascular anastomosis was 97% (90/93).<br>The most common complication of the pharyngoesophageal reconstruction with myocutaneous flaps or forearm flaps was fistula formation, but in our series of free jejunal graft transfer, it was observed in only 2 cases. As abdominal complication, intestinal obstruction was seen in only one case.<br>All but 3 patients were able to maintain adequate swallowing function and can eat regular diet within 30 minutes. Twelve patients developed esophageal speech.<br>In conclusion, because of the minimum rate of fistula formation and acceptable swallowing function, we think free jejunal autograft is the best methods for pharyngoesophageal reconstruction to date.

DOI： 10.5981/jjhnc1974.17.2_122

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Language：Japanese  

DOI： 10.5106/jjshns.18.39

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DOI： 10.5981/jjhnc.33.17

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Language：Japanese  

DOI： 10.5106/jjshns.17.35

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Language：English  

Reconstruction after total pharyngo-esophagectomy has been a formidable challenge to head and neck surgeons. To clarify the advantages and disadvantages of different reconstructive methods after total pharyngo-esophagectomy, we retrospectively compared three methods of reconstruction from the point of view of blood loss, duration of surgery, complications, and functional results after surgery. Seventeen male patients with cancer of the hypopharynx or advanced cancer of the cervicothoracic esophagus with an age range from 54 to 72 years were included in this study. The reconstructive procedures consisted of gastric pull up (n=5), elongated gastric roll with micro-vascular anastomosis (n=7), and gastric pull up with free jejunal graft (n=5). There was no difference in the amount of blood loss or the average duration of surgery between each procedure. One case with gastric pull up developed a partial necrosis of the graft. In another case with gastric pull up with free jejunal graft, we found an anastomatic leakage. Although, no anastomatic leakage occurred in the cases with elongated gastric roll with micro-vascular anastomosis, complications related to resection were more frequent in these cases than in the other two procedures. One patient with elongated gastric roll with micro-vascular anastomosis and another patient with gastric pull up with free jejunal graft developed esophageal speech. These results suggest that there is no apparent difference amongst the three procedures and selection of the procedure should be done keeping in mind any associated systemic disease and/or the socio-economic condition of the patients who undergo total pharyngo-esophagectomy. © 2007, Japan Society for Head and Neck Cancer. All rights reserved.

DOI： 10.5981/jjhnc.33.17

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DOI： 10.5981/jjhnc.31.465

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Language：English  

To clarify the long-term results of connection between the cut-end of the right clavicle and the 1st rib in cases with mediastinal tracheostoma, the consequence of this connection and movement of the shoulder joint were reviewed. Six patients with cancer of the cervical esophagus extending into the thorax, and one patient with thyroid cancer, were treated with extensive circumferential resection of the mediastinal trachea. In all cases, the upper sternum and more than one-third of the right clavicle were removed, and bilateral accessory nerves were preserved upon neck dissection. Medical records of these patients were reviewed for shoulder pain, consequence of the stainless steel wire used for the connection, abduction angle, and torque of the shoulder joint, at more than six months after surgery. The wires were preserved in three cases, whereas in three cases at more than six months after surgery, the wires were cut, and in one case, the wire was disconnected from the clavicle. The abduction angle of three patients whose wires were preserved was more than 135°, and they did not complain of shoulder pain. The abduction angle of two out of three, whose wire was cut, was more than 135°, and that of the third one was 120°, and none of these patients complained of shoulder pain. One patient whose wire was disconnected has a poor abduction angle and a complaint of shoulder pain. The torque could be measured in four cases. The right shoulder torque in three out of four cases was equal to that of the left side. The torque of the cases with a successful wire-connection, or those that were cut more than six months after surgery, was not reduced, and the abduction angle of shoulder was well-preserved. Therefore, connecting the cut-end of the right clavicle and the 1st rib should be preferred in cases with mediastinal tracheostoma plasty. © 2005, Japan Society for Head and Neck Cancer. All rights reserved.

DOI： 10.5981/jjhnc.31.465

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Language：English   Publisher：ELSEVIER SCI LTD  

Objective: In order to clarify the factors affecting the survival of flaps, we performed a retrospective study on free flaps (187) used for reconstruction in head and neck surgery in 182 patients. Methods: Free jejunum flaps were used on 68 occasions, rectus abdommus myocutaneous flaps on 67. radial forearm flaps on 49, scapular osteocutaneous flaps on 2 and latissimus dorsi myocutaneous flap on ones occasion, during the period from May 1996 to April 2003. Post-operative circulatory complications at the recipient site were analyzed mainly in relation to a history of previous surgery, radiotherapy and chemotherapy. Results: Circulatory crisis was observed in seven cases and circulation was restored in two of them after emergency exploration, whereas the other five flaps failed to survive. The overall failure rate of free flaps was 2.7%. Wound infection at the recipient site was frequent in patients with a history of previous local cervical surgery. Flap failure was significantly more frequent in patients with a history of previous surgery and infection, except for 2 patients in whose case the microsurgical technique was inadequate. Flap failure was not observed in those patients whose irradiation field could be analyzed, or in the patients who received chemotherapy. Although the incidence of circulatory crisis as a consequence of inadequate microsurgical technique was observed in the early period of this retrospective study, their frequency has diminished in the last 2 years. Conclusion: The survival of flaps was affected by a history of previous surgery following wound infection, although a history of irradiation and chemotherapy would have no effects on flap failure. The appropriate choice of vessels and surgical skill are crucial for the success of free flaps from our experience. Emergency exploration was also crucial for the survival of the flap in the case of circulatory crisis. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.anl.2004.03.003

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DOI： 10.5981/jjhnc1974.29.541

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DOI： 10.5981/jjhnc1974.29.541

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

In order to evaluate the effect and strategy of surgical treatment in patients with bilateral neck metastases of head and neck squamous cell carcinoma, a retrospective pathological study was carried out over a period of ten years. The five-year-survival rate of 16 cases of laryngeal carcinoma with pathological bilateral metastases was 31%. This rate was the best among all the cases of head and neck carcinoma included in this study. The survival rate of 32 hypopharyngeal carcinomas with pathological bilateral metastases was 19%. The number of histologically positive lymph nodes seemed to be of prognostic importance, since there was a statistically significant difference in survival between cases with six or more positive lymph nodes and less than six. Adjuvant chemotherapy was not effective in hypopharyngeal carcinoma, since there was no statistically significant difference in survival between those cases treated with and without adjuvant chemotherapy. The survival rate of 16 oropharyngeal carcinomas with pathological bilateral metastases was 13%, this being the worst in this study. Preoperative radiotherapy or neo-adjuvant chemotherapy followed by radiotherapy was effective in 29% of cases with oropharyngeal carcinomas with clinical bilateral metastases. After such therapy, these cases had no pathological residual tumors in cervical nodes, and the patients had long-term survival. This suggests that it is important to determine good responders with clinical bilateral metastases of oropharyngeal carcinoma treated preoperatively with radiotherapy and neoadjuvant chemotherapy, followed by radiotherapy. The survival rate of 16 lingual carcinomas with pathological bilateral metastases was 19%, but the cases with clinically and pathologically obvious bilateral metastases had a poor prognosis, with short-term (less than 2 years) survival. The patients with lingual carcinoma whose neck metastatic level of positive nodes was level III or more, also had a poor prognosis. Indication for surgery is thoroughly discussed in such cases with lingual carcinoma.

DOI： 10.5981/jjhnc1974.26.504

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Other Link： http://search.jamas.or.jp/link/ui/2004030786

Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

In order to evaluate the effect and strategy of surgical treatment in patients with bilateral neck metastases of head and neck squamous cell carcinoma, a retrospective pathological study was carried out over a period of ten years. The five-year-survival rate of 16 cases of laryngeal carcinoma with pathological bilateral metastases was 31%. This rate was the best among all the cases of head and neck carcinoma included in this study. The survival rate of 32 hypopharyngeal carcinomas with pathological bilateral metastases was 19%. The number of histologically positive lymph nodes seemed to be of prognostic importance, since there was a statistically significant difference in survival between cases with six or more positive lymph nodes and less than six. Adjuvant chemotherapy was not effective in hypopharyngeal carcinoma, since there was no statistically significant difference in survival between those cases treated with and without adjuvant chemotherapy. The survival rate of 16 oropharyngeal carcinomas with pathological bilateral metastases was 13%, this being the worst in this study. Preoperative radiotherapy or neo-adjuvant chemotherapy followed by radiotherapy was effective in 29% of cases with oropharyngeal carcinomas with clinical bilateral metastases. After such therapy, these cases had no pathological residual tumors in cervical nodes, and the patients had long-term survival. This suggests that it is important to determine good responders with clinical bilateral metastases of oropharyngeal carcinoma treated preoperatively with radiotherapy and neoadjuvant chemotherapy, followed by radiotherapy. The survival rate of 16 lingual carcinomas with pathological bilateral metastases was 19%, but the cases with clinically and pathologically obvious bilateral metastases had a poor prognosis, with short-term (less than 2 years) survival. The patients with lingual carcinoma whose neck metastatic level of positive nodes was level III or more, also had a poor prognosis. Indication for surgery is thoroughly discussed in such cases with lingual carcinoma.

DOI： 10.5981/jjhnc1974.26.504

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Other Link： http://search.jamas.or.jp/link/ui/2004030786

Language：English   Publisher：The Medical Association of Nippon Medical School  

To elucidate the presence and distribution of Endothelin-1 (ET-1) in tissues of human salivary glands, we performed an immunohistochemical analysis of ET-1 in 15 normal salivary glands, 8 adenolymphomas, 13 pleomorphic adenomas and 5 carcinomas, using the mouse monoclonal antibody against human ET-1. In normal glands, immunoreactivity for ET-1 was observed in the striated duct cells. In adenolymphomas, the columnar cells of the granular epithelium showed strong intracytoplasmic immunoreactivity. In carcinomas, moderate or strong immunoreactivity was observed in the tumor cells, whereas in pleomorphic adenomas, weak immunoreactivity was observed. A good relation was detected between the size of pleomorphic adenoma and ET-1 immunoreactivity, as well as between the duration of tumor in carcinoma and ET-1 immunoreactivity. The presence and distribution of ET-1 in salivary glands and salivary gland tumors suggests a possible role for ET-1 in the regulation of electrolytes and water transport in salivary glands, and as a growth-promoting factor for tumors. (J Nippon Med Sch 1998; 65 : 471-477)

DOI： 10.1272/jnms1923.65.471

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Language：Japanese   Publisher：Oto-Rhino-Laryngological Society of Japan Inc.  

The charts of 319 consecutive patients who underwent total laryngectomy at the Cancer Institute Hospital from 1971 to 1994 were reviewed in order to clarify the relationship between pharyngo-cutaneous fistula formation and age, the dose of pre-operative radiation and radical neck dissection, as well as the need for subsequent surgical repair. The patients did not need to undergo reconstruction by flaps at the time of laryngectomy. Radiation sources were limited to X ray radiotherapy and Cobalt 60. Of the 319 patients 204 (63.9%) underwent neck dissection. Both radical neck dissection and modified radical neck dissection were classified as neck dissection. The chi-square test was used to construct a table of the three parameters age, dose of radiation and neck dissection. With respect to age, the incidence of fistula formation was 13.4% (16 patients of 119) in patients at the age of 59 and below, 5.9% (7/118) in those from 60 to 69, and 8.5% (7/82) in those at 70 years and above. Our analysis reveals that the age at the time of surgery is not a predisposing factor for fistula formation in the three age groups (59 and below, between 60 and 69, and 70 and above). Similarly the need for subsequent surgical repair is also not age-related. With respect to radiation, the incidence of fistula formation was 8.0% (4/50) for patients who received radiotherapy less than 20 Gy, 6.3% (2/32) in those who received between 20 and 40 Gy, 2.6% (2/77) in those who received between 40 and 60 Gy, 13.2% (20/152) in those who received between 60 and 80 Gy and 25.0% (2/8) in those who received over 80 Gy. When the preoperative dose of radiation was divided into three classes, that is, less than 40 Gy, 40 to 60 Gy and over 60 Gy, we observed that the incidence of fistula formation increased significantly in the patients who received over 60 Gy. Surgical repair was also indicated more frequenly for those patients who received over 60 Gy than for those who received less than 60 Gy. With respect to neck dissection, the incidence of fistula formation was 12.2% (14/115) for the patients who did not undergo neck dissection or those who underwent only lymphadenectomy, 7.8% (9/115) for the patients who underwent unilateral neck dissection, and 7.9% (7/89) for those who underwent bilateral neck dissection. These data reveal that neck dissection, whether unilateral or bilateral, dose not increase the incidence of fistula formation, nor the need for subsequent surgical repair. Fistulae were present in 30 patients (9.4%) for 24 years, and 14 of these 30 patients did not need subsequent surgery. In these 30 patients with fistulae, we did not find patients with systemic disease such as diabetes mellitus prior to the surgery. When the period of 24 years was divided into 4 periods, the incidence of fistula formation was 19.0% (from 1971 to 1976), 6.9% (from 1977 to 1982), 10.3% (from 1983 to 1989) and 2.6% (from 1989 to 1994), that of the latest priod was the lowest with gradual improvement. The average dose of preoperative radiation was 57.7 Gy (from 1971 to 1976), 50.8 Gy (from 1977 to 1982), 39.6 Gy (from 1982 to 1988)and 45.7 Gy (from 1989 to 1994) and reduction in dose of radiation seemed to be one of the reasons for the lower frequency of fistula. Several surgeons performed the operations for different patients, but the procedure of laryngectomy was recently directed by an experienced surgeon. The study also indicates that the risk of fistula formation is reduced not only by the dose of radiation but also by improved surgical skill.

DOI： 10.3950/jibiinkoka.100.213

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Language：English  

Sixteen patients with lymphatic metastases to the neck and a histological diagnosis of undifferentiated carcinoma from an unknown primary lesion were assessed using immunohistochemical staining. The results revealed a non-epithelial tumor in 11 cases (malignant lymphoma in 5 cases) and an epithelial tumor in 3 cases. The patients with malignant lymphoma had a good outcome, but those with other non-epithelial tumors did not. Treatment of patients with an unknown primary tumor, especially undifferentiated carcinoma, should be carefully evaluated based on immunohistological examinations to identify malignant lymphoma. © 1994, The Oto-Rhino-Laryngological Society of Japan, Inc. All rights reserved.

DOI： 10.3950/jibiinkoka.97.2202

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DOI： 10.3950/jibiinkoka.97.2202

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