We reported the clinical symptoms, treatment and the convalescence about 130 examples of parotid carcinoma which we treated in Osaka Medical College. 5 years disease specific survival rate (DSSR) were 100% for stage I,95.2% for stage Ⅱ, 70.4% for stage Ⅲ and 45.1% for stage Ⅳ. While low or intermediate grade malignancy cases (80 examples) were 95.1%, high grade malignancy cases (50 examples) was 36.6% (p < 0.001). In immunohistochemistry, DSSR were 85.0% for EGFR positive and 96.7% for EGFR negative (p = 0.15), 57.0% for HER2 positive and 95.6% for HER2 negative (p < 0.001), 67.1% for AR positive and 93.6% AR negative (p < 0.001). The cases with malignant three signs (pain, facial nerve paralysis and adherence) were low DSSR. Median in recurrence time was 5 months, and the salvage surgery for recurrence cases was difficult.

The standard of care for patients with recurrent and metastatic head and neck squamous cell carcinoma (RM-HNSCC) is chemotherapy with platinum, 5-FU and cetuximab. Recent breakthrough in cancer immunotherapy employing PD-1/PD-L1 immune checkpoint inhibitors has evolved into number of clinical trials with anti PD-1 antibody for patients with RM-HNSCC. CheckMate141 trial demonstrated that treatment with Nivolumab resulted in longer overall survival than that with single-agent therapy among patients with platinum-refractory, RM-HNSCC. The positioning of immunotherapy in the treatment of RM-HNSCC is discussed, by focusing on how immunotherapy and chemotherapy should be differentially applied for the treatment of RM-HNSCC. To this end, I report a case of tumor flare-up after treatment with immune checkpoint inhibitors, but representing a dramatic response in the next line of chemotherapy treatment. Interestingly, there is a discrepancy of Kaplan‒Meier curves between overall survival and progression free survival in CheckMate141 trial. These findings raise a possibility that outcome of salvage chemotherapy is improved after exposure to immunotherapy. Lastly, PD-L1 expression may be important as a predictive biomarker for immune checkpoint inhibitors, but care must be taken when interpreting the results of PD-L1 immunohistochemistry.

Background：The aim of the present study was to illustrate the utility of the multilayer resection of esthesioneuroblastomas (ENB) using endoscopic endonasal approach (EEA). Methods：We retrospectively reviewed patients treated at 10 tertiary referral hospitals in Japan with a diagnosis of ENB. Results：A total of 32 patients (15 male；mean age at presentation, 51.3 years) underwent multilayer resection of ENBs using EEA. Thirty patients were newly diagnosed and two presented with recurrent disease. Dulguerov staging at presentation was T1, 6 patients；T2, 10 patients; T3, 8 patients；and T4, 8 patients. EEA alone was performed in 24 patients, and EEA with transcranial approachwas performed in 8 patients. The mean period of follow-up was 40.3 months. No post-operative complications were identified. Pathological margin studies revealed margin-free resections in 31 patients. All patients were alive at the last follow-up. Of the 14 patients who underwent EEA alone with olfaction preservation, olfaction was remained in 13 patients. Conclusions：The results of the present study indicate the safety and utility of multilayer resection using EEA for treatment of ENBs.

In Japan, there are three major endoscopic surgical technics for pharyngeal cancers：Transoral Robotic Surgery (TORS)；Endoscope Laryngo-Pharyngeal Surgery (ELPS)；Transoral Videolaryngoscopic Surgery (TOVS). I report three cases of pharyngeal cancers resected by endoscopic and microscopic surgeries. Case 1 was 58-year-old-male with hypopharyngeal cancer. ELPS was performed. Case 2 was 51-year-old-femail with lateral wall oropharyngeal cancer. Microscopic resection with FK-WO retractor was performed. Case 3 was 74- year-old-male with anterior wall oropharyngeal cancer. For hypopharyngeal cancers, ELPS is more useful than TORS. ELPS with Sato's curved laryngoscope is performed under excellent surgical fields. However, surgical field with FK-WO retractor is not enough for TORS because robotic arms and camera are straight and wide. For lateral and anterior wall oropharyngeal cancers, TORS with 3D camera and wide range motion arms is useful. The problems of TORS are medical expenses without insurance and lack of tactile sensation. Some articles reported that TOVS is useful for hypopharyngeal and anterior wall oropharyngeal cancers. Surgeons should be familiar with peculiarity of each technics.

Major surgery for the resection of head and neck cancer followed by free tissue transfer reconstruction requires botha long operation time and multiple surgical fields and is thus relatively invasive for patients. However,current perioperative management relies on traditional methodologies that are largely undeveloped and which are implemented at individual facilities. At our institution, perioperative management of these surgeries since September 2016 has been conducted according to our own Enhanced Recovery After Surgery (ERAS) protocol for head and neck cancer. In the 11 cases managed by the ERAS group thus far, water balance was significantly improved and postoperative weight gain was suppressed compared with the most recent control group of 60 cases. In the ERAS group, hemodynamics were stabilized, and decreases in blood pressure occurred in only a few patients. C-reactive protein levels were significantly lower in the ERAS group. Postoperative vomiting did not occur in the ERAS group, in contrast to seven patients in the control group. Major complications such as flap necrosis and leakage were not observed in the ERAS group, but in four patients in the control group. These data indicate that our ERAS protocol can reduce the invasiveness associated with major head and neck surgeries followed by free tissue transfer reconstruction.