Abstract
Ten years have passed since the Japan Society for Head and Neck Surgery started to certify surgeons and institutes as board-certified specialists or special institutes in order to standardize and equalize head and neck treatment in Japan. This paper presents the current situation in Hyogo prefecture and in our hospital, Kobe City Medical Center General Hospital （KCGH）, as a representative municipal hospital. In Hyogo, there are 14 Cancer Base hospitals authorized by the national government, two of which do not employee full-time head and neck surgeons, especially in the northern part. We have five board-certified institutions in Hyogo, all of which are located in the southeastern part. According to DPC data in 2017, more than 60％ of head and neck patients were treated in these board-certified institutions. Our hospital, KCGH, is one of the board-certified institutions and we treated 308 head and neck patients and performed 288 head and neck operations in 2017. Because of the lack of beds in KCGH （13 beds are currently available for head and neck tumor treatment）, we need to minimize the period of hospitalization. In fact, the average period in our institution is the shortest among the five board-certified institutions （18.7 days）. This point may hinder the adoption of standardized treatment, especially in the field of chemoradiotherapy （CRT）. We use low-dose weekly CDDP, which is currently categorized as Category 2B in the NCCN guideline, as first-line concurrent chemotherapy, because this procedure can be started from the outpatient clinic. Another limitation is the lack of plastic surgeons for head and neck reconstruction, which sometimes requires us to use a pedicle flap even for reconstruction of oral cancer.
Key words：Standardization of head and neck cancer treatment, Hyogo prefecture, Municipal hospital
