Transoral Videolaryngoscopic Surgery (TOVS) による経口的中咽頭癌切除術

抄録

　We developed transoral videolaryngoscopic surgery (TOVS) as a minimally invasive surgical procedure for supraglottic, laryngeal, oropharyngeal, and hypopharyngeal cancers. TOVS is a novel, easy-to-use surgical procedure for transoral en bloc resection and involves use of a laryngopharyngeal retractor or distending laryngoscope, a rigid or deflectable videoendoscope, and laparoscopic surgical instruments. The advantages of this procedure are as follows. In transoral surgery, it can provide advantages similar to those of robotic surgery, such as wide field of view and working space. It is an easy procedure for otolaryngologists to perform without special training because it is an extension of well-known surgeries such as tonsillectomy or laryngomicrosurgery. Tactile sensation is retained during surgery; this is important for safe and reliable resection. Finally, this procedure can be performed at a low cost.
　Thus far, transoral oropharyngeal cancer resection using TOVS has been performed for 28 patients (29 lesions) in our institution. The resected lesions consisted of 8 T1 lesions, 14 T2 lesions, and 7 T3 lesions. There were no T4 tumors in this series. Sixteen patients (55.2%) had no nodal metastasis, while 13 patients (44.8%) were positive for nodal metastasis. Seventeen patients (58.6%) underwent neck dissection with TOVS. One patient underwent tracheotomy, and 9 (32.1%) received TOVS followed by conventional radiotherapy. None of the patients underwent reconstructive surgery. The median follow-up period in all the cases was 42 months. The 3-year crude survival rate, 3-year disease-free survival rate, and 3-year local control rate were 94.1%, 100%, and 95.5%, respectively. Postoperative swallowing function in the patients was satisfactory. TOVS for T1, T2, and some T3 oropharyngeal cancers contributed to functional preservation while maintaining cancer curability.