Head and Neck Surgery

By bringing together the skills and experience of our experts, we aim to work as a team to promote minimally invasive endoscopic surgery and proactively treat difficult cases.

Kobe City Medical Center General Hospital
Head and Neck Surgery Director

Masahiro Kikuchi

Head and neck tumors are tumors that occur in the head and neck region, that is, from the face to the neck. Tumors are divided into malignant and benign, and malignant diseases are called "cancer." Therefore, malignant tumors that occur in the head and neck region are collectively called "head and neck cancer." Head and neck cancers ^* include oral cancer (tongue cancer, gingival cancer, etc.), pharyngeal cancer (nasopharyngeal cancer, oropharyngeal cancer, hypopharyngeal cancer), laryngeal cancer, nasal and paranasal sinus cancer, salivary gland cancer (parotid gland cancer, submandibular gland cancer, etc.), and thyroid cancer. In addition to treating these head and neck cancers, our department also treats many benign head and neck tumors.

(For a detailed explanation of head and neck cancer, please see the website of the Japan Society of Head and Neck Cancer: http://www.jshnc.umin.ne.jp/general/index.html)

We also treat tumors occurring not only in the head and neck region, but also in the skull base, mediastinum, and orbit in cooperation with Neurosurgery, Respiratory Sugery, and Ophthalmology. The head and neck region is essential for life support, such as chewing, swallowing, speaking, and breathing, and cancer occurring here significantly impairs these functions. In particular, when treating tumors occurring in the face, consideration of aesthetics is essential. In treatment, it is important not only to cure the cancer, but also to maintain the quality of life and appearance. Treatment policies are decided through regular conferences with our hospital's radiation oncologists and Oncology, and the stage of cancer progression, the patient's overall condition, and social background are comprehensively evaluated, and the treatment method appropriate for each patient is presented at Head and Neck Surgery specialist outpatient clinic. The characteristics of head and neck cancer treatment in our hospital's Head and Neck Surgery are as follows.

① We are able to provide optimal treatment (surgery, radiation therapy, chemotherapy) to patients, regardless of the location or stage of cancer, from early to advanced stages, under the supervision of specialists with extensive experience in head and neck cancer treatment.
② Promoting minimally invasive endoscopic surgery
For early-stage pharyngeal cancer Gastroenterology will insert an endoscope through the mouth and Head and Neck Surgery will use a monitor to perform oral laparoscopic surgery to remove the cancer.
・For early-stage nasal sinus cancer and anterior skull base malignant tumors such as olfactory neuroblastoma, we perform transnasal endoscopic surgery for malignant nasal sinus tumors (surgery in which a thin endoscope is inserted through the nose to remove the tumor), which avoids craniotomy and facial incisions. In addition, for tumors occurring deep in the face, such as the pterygopalatine fossa and infratemporal fossa, we perform surgery that leaves no or minimal scars on the face or head, using transnasal endoscopic surgery alone or in combination with a small facial incision. These treatments are performed primarily by doctor who are certified as both Head and Neck Cancer Supervisor and rhinology surgery specialists, making them minimally invasive endoscopic surgeries that do not compromise their curative potential.
③ Capable of handling difficult cases
・For advanced cancers where the tumor is large and has spread to the surrounding area, radiation therapy is often insufficient to achieve a complete cure, so extensive surgery to widely remove the cancer along with the surrounding organs and reconstructive surgery to reassemble the area lost during the resection are necessary. In our department, we work in cooperation with related departments such as Plastic Surgery, dental and oral surgeons, and gastroenterological surgeons to actively perform surgery for locally advanced cancers that require reconstruction. We have particularly well-developed clinical techniques in oral and Plastic Surgery, and are able to plan treatments that take into account postoperative functional reconstruction.
・Salvage surgery to save the lives of patients who have experienced a recurrence after radiation therapy is high-risk and difficult, but we perform it according to the patient's condition. We also proactively perform surgical treatment on cases that are difficult to treat at other facilities, such as salvage surgery under a nasal endoscope for recurrence after radiation therapy for nasopharyngeal cancer.
・For skull base tumors with intracranial invasion, we work as a team with Neurosurgery. Head and Neck Surgery is responsible for the resection of extracranial tumors using a transfacial or transnasal endoscopic approach.
・For elderly patients and patients with underlying diseases, we work with related departments to assess the risks of treatment and provide standard or equivalent treatment, and also provide palliative care as needed.
・We provide photoimmunotherapy for unresectable locally advanced or locally recurrent head and neck cancer after completion of standard treatment.
4) The hospital has a wide range of treatment options other than surgery, including radiation therapy, chemotherapy, and superselective intra-arterial chemoradiotherapy (RADPLAT), as well as a full range of clinical skills provided by radiation therapists, medical Oncology, and endovascular therapists.
・In cooperation with nearby medical institutions, we can also provide treatments such as heavy ion therapy, proton therapy, and boron neutron capture therapy (BNCT).
⑤ With regard to the treatment of thyroid diseases, there are sufficient endocrinologists, nuclear medicine radiotherapists, and Oncology, and comprehensive treatment is possible through cooperation from surgery, radioactive iodine therapy, to molecular targeted drug therapy. In addition, regarding voice disorders associated with thyroid surgery, voice improvement surgery is also possible, taking advantage of the technology of Otorhinolaryngology department.

In addition, we are a core facility for Otorhinolaryngology specialty training programs certified by Japanese Medical Specialty Board, Certified Medical Specialist THE JAPAN BRONCHO-ESOPHAGOLOGICAL SOCIETY, a training facility designated by the Japan Society of Head and Neck Surgery and Neck Board Certified Surgeon, and a certified facility for Endocrine Surgeon and thyroid surgery, and we are committed to training Board Certified Otorhinolaryngologist, Head and Neck Cancer Specialist specialists, endocrine surgeons, Board Certified Bronchoesophagologist. Clinical research is also active, and on average, we present at about three international conferences, about ten domestic conferences, and publish papers in about three English journals and about five Japanese journals each year, aiming to become Head and Neck Surgery treatment facility that is recognized overseas (for academic achievements, please refer to Otorhinolaryngology > Announcements section).

Head and Neck Surgery, we mainly diagnose and examine tumors that have occurred in the head and neck area, and provide treatment centered on surgery and radiotherapy.

〈Outpatient department specializing in Head and Neck Surgery〉

Head and Neck Surgery specialty outpatient clinics are available after an initial consultation with Otorhinolaryngology or an oral surgeon. We have Otorhinolaryngology outpatient clinic three times a week and an oral surgery Head and Neck Surgery once a week.We mainly examine patients with head and neck cancer.

In the treatment of head and neck cancer, it is important to consider not only the cure (how much cancer can be cured) but also how to maintain the quality of life (QOL) after treatment. In the treatment of head and neck cancer, surgery or radiation therapy is used for early-stage cancer, and multidisciplinary treatment combining surgery, radiation therapy, and chemotherapy is used for advanced cancer, providing the best treatment for each patient. Otorhinolaryngology Two physicians, Head and Neck Cancer Specialist and doctor, who are supervising physicians, see patients every week in the outpatient clinic of the Department of Cancer and Cervical Cancer.

Treatment strategies are discussed at weekly conferences with Otorhinolaryngology Head and Neck Surgery and biweekly radiation conferences with Otorhinolaryngology Head and Neck Surgery, radiation oncologists, and Oncology. We comprehensively evaluate the degree of progression (disease stage, stage), general condition of the patient, and social background, and present treatment methods suitable for each patient at Head and Neck Surgery. For this reason, we do not offer treatment policies that are biased toward individual or clinical department decisions, such as positively recommending surgery or actively recommending radiotherapy. After the treatment policy is decided, we provide team medical care by specialists.

<Surgery>

Nasal and paranasal sinus tumors, salivary gland tumors such as parotid and submandibular glands, oral cancer such as tongue cancer and gingival cancer, mid- and hypopharyngeal cancer, laryngeal cancer, cervical esophageal cancer, thyroid cancer, We perform surgery for parathyroid tumor.

The head and neck region includes sensory organs such as hearing, smell, and taste, and organs involved in vital functions such as eating, swallowing, vocalization, and breathing. In addition, since it is an area related to aesthetics (appearance) such as the face and neck, we are careful not only to be radical, but also to consider postoperative aesthetics and preserve postoperative function.

For early-stage pharyngeal cancer, jointly with Gastroenterology, minimally invasive oral endoscopic surgery that does not cut the neck, or olfactory cancer without brain invasion, is performed. For anterior skull base malignant tumors such as neuroblastoma, we actively perform transnasal endoscopic surgery, which is a minimally invasive surgery that does not cut the face.

On the other hand, for advanced cancer, it is necessary to resect a wide area of tissue to completely remove the cancer, and in some cases postoperative sequelae such as dysphagia and dysphonia cannot be avoided. If vocal cords have been surgically removed and speech is no longer possible, it is sometimes possible to obtain a substitute voice by creating a tracheoesophageal shunt. In addition, if there is a large tissue loss after surgery, we perform reconstructive surgery using a free flap in cooperation with Plastic Surgery team.

The head and neck region is an anatomically very complex region surrounded by important organs such as the great blood vessels, brain, nerves, and eyeballs. Our hospital has not only Head and Neck Cancer Specialist and instructors, but also Otological Surgery Supervisor and nose surgery instructors Otorhinolaryngology We also perform team surgeries in which teams are formed within Head and Neck Surgery, and each anatomical specialist is in charge of the operation. For tumors such as the base of the skull and the superior mediastinum that straddle specialized areas other than Head and Neck Surgery surgery, such as Neurosurgery and Respiratory Sugery Respiratory Sugery, we perform joint surgery in cooperation with Neurosurgery and respiratory surgery.
　

<Radiation therapy>

Radiation therapy that irradiates radiation from outside the body is performed mainly for early-stage laryngopharyngeal cancer. It is possible to aim for a complete cure without losing the voice and without surgery. In the case of advanced cancer, radiation therapy may be performed according to the patient's wishes and condition, and its indication is at a radiation conference consisting of Otorhinolaryngology Head and Neck Surgery, radiation oncologists, and Oncology will be considered. Chemoradiotherapy (radiation therapy combined with anticancer drugs) may also be given to prevent recurrence after surgery. Intensity-modulated radiation therapy (IMRT) is used for treatment, and the irradiation dose is 50 to 70 Gy, and the irradiation period is about 5 to 7 weeks.

Medical record

Departmental statistics

Main diseases/treatments

Thyroid cancer (comprehensive treatment covering surgery, radioiodine therapy, and molecular-targeted drug therapy)

In addition to surgical therapy for thyroid cancer, specialists in various fields gather to provide multidisciplinary treatment, including postoperative radioiodine therapy and molecular-targeted drug therapy when radiation iodine is refractory.

clinical research

Notice regarding clinical research

Clinical studies whose study period has ended

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