2023 年 69 巻 2 号 p. 97-102
Remarkable progress has been achieved in head and neck surgery in recent years. Transoral robotic surgery (TORS) is becoming popular worldwide for the removal of less invasive tumors. TORS is used especially for oropharyngeal cancer and is minimally invasive, with a short treatment time and minimal postoperative dysfunction. The procedure is performed by inserting one endoscope and two robotic arms. The robotic arm has a 360-degree movable tip, which enables fine manipulation, even in narrow oral cavities. The endoscope also provides three-dimensional images and enables the surgeon to get close to the operative site, making it possible to check for small blood vessels and other objects while performing the operation.
Photoimmunotherapy is a new treatment for distant metastasis or recurrent head and neck cancers not indicated for surgery or radiotherapy. Treatment requires the administration of a dye, IR700, one day before the procedure. This dye disrupts cell membranes when exposed to near-infrared (NIR) radiation. To deliver this dye specifically to the tumor, an antibody drug against the epidermal growth factor receptor, which is expressed relatively specifically in tumors, is used. This treatment has a strong anti-tumor effect and the tumor shrinks relatively quickly. However, because NIR irradiation is required, the lesion must be within the infrared irradiation range. In addition, because of rapid shrinkage of the tumor, post-treatment tissue defects are serous complication, and tumor invasion into the carotid artery are contraindications due to the risk for major hemorrhage caused by tumor shrinkage.
