[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Currently, the programmed death-1 （PD-1） inhibitor pembrolizumab （P）, used either alone or in combination with platinum/5-fluorouracil （P＋C）, is standard first-line systemic therapy for platinum-sensitive recurrent or metastatic squamous cell carcinoma （R/M SCCHN）. We retrospectively reviewed 24 patients with R/M SCCHN treated with P or P＋C regimen in our department. The median progression-free survival was 2.1 months in both P and P＋C cohorts and the median overall survival （OS） was 7.0 months for the P cohort and 10.0 months for the P＋C cohort. Objective response rate was as high as 50.0％ for the P＋C cohort compared to 18.8％ for the P cohort. In a log-rank analysis, PS 2 patients were shown to have a poor prognosis, with a significantly worse OS of 4.7 months at PS 2 in the P cohort compared to PS 0/1 （p＝0.002）. Pembrolizumab alone should be carefully selected in patients with PS 2. On the other hand, P＋C is expected to be useful in cases requiring tumor reduction.

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Total thyroidectomy is recommended for patients with papillary thyroid carcinoma classified as high-risk according to the Japanese guidelines. For intermediate-risk patients, total thyroidectomy is recommended case by case. Therefore, it is difficult to decide the extent of the thyroidectomy in some cases. Accordingly, we investigated the clinical features of patients with papillary thyroid carcinoma who underwent total thyroidectomy at Nagoya City University. A total of 72 patients underwent total thyroidectomy between July 2012 and July 2022. High-risk patients were the majority. Most of the intermediate-risk patients had metastatic lymph nodes at the lateral lesions. The progression-free survival rate of high-risk patients was poor in this study. In intermediate-risk patients, patients with metastatic lymph nodes at the lateral lesions were suggested to have a high risk of recurrence or metastasis. Therefore, total thyroidectomy should be considered for such patients, while striving to prevent complications.

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Undifferentiated pleomorphic sarcoma （UPS） arising from head and neck lesions accounts for less than 1％ of all head and neck tumors and has a poor prognosis. Here, we retrospectively reviewed patients with head and neck UPS who underwent surgery at the Department of Head and Neck Surgery, National Cancer Center Hospital between 2013 and 2021. A total of eight patients were included in this study. Four patients died of the disease; both local recurrence and distant metastases had developed in two patients, and distant metastases had developed in the other two at the last follow-up. The 2-year overall survival rate and local control rate were 45％ and 75％, respectively. If the tumor is resectable, complete resection can serve as a curative treatment for head and neck UPS. Even in case of positive surgical margins, the administration of a sufficient dose of postoperative radiotherapy may contribute to achieving local control. The development of effective chemotherapy for distant metastases is needed to improve survival outcomes.

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Occasionally, hearing acuity that had once improved after middle ear surgery worsens again. Especially in children, there are some cases in which hearing deteriorates as they grow up after undergoing surgery in childhood. We investigated 12 patients who underwent initial surgery at our hospital and underwent reoperation between 2013 and 2022. The ages ranged from 11 to 70 years old; there were 9 TEES and 3 MES surgical procedures. When hearing deterioration occurs, various causes such as fixation and disconnection of the auditory ossicles, tympanic granulation, etc. are considered. We investigated the pathology of the tympanic chamber and the auditory ossicles when reoperation was performed, separately for children and adults. By performing TEES, it became easier to understand the pathology of conductive hearing loss, and because it is minimally invasive, it became possible for patients to think positively about reoperation.

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We have been performing extracapsular dissection （ECD） on patients with Warthin tumor since 2018 and report the results here. ECD was performed on 9 untreated patients with 11 tumors, including 4 deep lobe tumors. All patients were operated under facial nerve monitoring. We planned to remove the tumor with a small cuff of normal parotid parenchyma all around the tumor capsule after meticulous dissection of the superficial lobe, but most tumors were removed with partially attached parotid tissue due to exposure out of the parotid gland or contact with the facial nerve. The removal methods for all deep lobe tumors became extracapsular enucleation. Although operation time was not as short as in previous reports because the tumors in this study were relatively large and included deep lobe tumors, the surgery was performed without complications. The use of intraoperative facial nerve monitoring may expand the indications for ECD.

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Submandibular gland excision is generally performed for submandibular gland junction salivary stones; however, in recent years, less invasive surgical options have been explored. In this study, we report eight cases of salivary stones at the hilar gland observed using a nasal endoscope and excised via the intraoral method. We evaluated the usefulness of the nasal endoscope-assisted intraoral method and compared it with the macroscopic intraoral method and submandibular gland extirpation. The nasal endoscope-assisted intraoral method is advantageous in terms of visualizing the deep part of the oral cavity floor in detail, which is a blind spot to the naked eye, and the surgeon and assistant can share a good view of the surgical field. The operation can be performed simultaneously by two operators, thus reducing the operation time as well as complications and improving educational effects. The nasal endoscope-assisted intraoral method is considered a useful surgical method worth performing in cases where it is difficult to introduce a salivary gland duct endoscopy.

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We investigated the usefulness of G8 as a simple screening tool for elderly head and neck cancer patients by using the tool to assess geriatric function and to investigate the prognosis and other factors. The subjects were 37 head and neck cancer patients aged 70 years or older who visited our department for primary treatment during a two-year period from January 2018 to December 2019. The cutoff value of the G8 score was 10.5, calculated from the relationship between the G8 score and prognosis. The three-year overall survival rate was 88.0％ for the G8 value ≥11 group and 35.3％ for the G8 value ＜11 group, showing a significant difference between the two groups. The results suggested the efficacy of G8 as a prognostic indicator in elderly patients with head and neck cancer.

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We performed tracheal resection with end-to-end anastomosis for four patients （1 man, 3 women; 67–86 years old） in whom thyroid cancer widely invaded the trachea. Prophylactic tracheostomy was performed in two patients during surgery, and urgent tracheostomy due to postoperative laryngeal edema was performed in one patient. Although some studies have reported that tracheostomy is contraindicated for patients with tracheal end-to-end anastomosis, incision with minimal size and enough distance from the point of anastomosis may make it a safe and reliable procedure without any complications.

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Isolated stapes superstructure fixation is rare compared to footplate fixation. Herein, we present the case of a patient with isolated bilateral stapedial ankylosis with superstructure fixation. The patient showed bilateral conductive hearing loss that was similar in both ears, and high-resolution computed tomography showed a bony connection between the stapes superstructure and the tympanic cavity wall in both ears. This was suggested to be the cause of conductive hearing loss, and so type I tympanoplasty was performed in the right ear and then in the left ear. The fixation of the stapes superstructure to the pyramidal eminence by a bony bar was seen in both ears intraoperatively. The dissection of the bony bar mobilized the stapes, and improved the hearing thresholds of both ears. Thus, for this patient, high-resolution computed tomography was helpful for detecting the fixation.

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Apocrine adenocarcinoma is a rare tumor that originates from the apocrine gland. Most of them are reported to occur in the axilla; apocrine adenocarcinoma arising from the eyelid is extremely rare. We experienced a case of apocrine adenocarcinoma that arose from the lower right eyelid. The case was a man in his 70s who visited an ophthalmologist with a chief complaint of right lacrimation. The ophthalmologist found him to have a right orbital tumor by using enhanced MRI. Because the tumor may have extended to the nasolacrimal duct, he was referred to the Yamaguchi University Department of Otolaryngology for treatment. We diagnosed an apocrine adenocarcinoma originating in the right lower eyelid. Since the cancer was non-metastatic, we performed right orbital total exenteration and partial maxillary resection as cancer treatment.
Treatment of apocrine adenocarcinoma is often based on surgical resection; no consensus has been established regarding the usefulness of radiotherapy and chemotherapy for treatment. Apocrine adenocarcinoma is considered to have a relatively good prognosis. However, it is suggested that there may be some cases with high malignancy. Therefore, we consider that careful follow-up is necessary for patients after treatment for apocrine adenocarcinoma.

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Eagle’s syndrome is a disorder that causes a variety of symptoms due to an over-lengthening of the styloid process. In typical cases, compression or strangulation of the inferior cranial nerves causes pharyngeal pain, dysphagia, facial pain, and neck pain, while in rare cases, compression or dissection of the internal carotid artery causes transient ischemic attack or cerebral infarction. In the present study, we experienced a case of Eagle’s syndrome as the cause of repeated cerebral infarctions. The patient developed cerebral infarction due to compression of the carotid artery by an overgrowth of the styloid process. Amputation of the styloid process was an effective treatment for the infarction, with no recurrence for one year after the operation.

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Although metastasis to the cervical lymph nodes from distant primaries is uncommon, genitourinary tract neoplasms, especially renal and prostate cancers, account for a significant proportion of such cases. However, metastasis of bladder cancer to the cervical lymph nodes is extremely rare. Herein, we report a patient with stage Ⅳ （T2N2M1） bladder urothelial carcinoma who once had shown complete response to a total of 14 cycles of systemic chemotherapy （Gemcitabine-CDDP） but a follow-up PET-CT five years later suggested that recurrent metastasis had developed to the left supraclavicular fossa lymph node. Since the distant metastasis was solitary and considered amenable to R0 resection, we performed selective level Ⅳ＋VB neck dissection instead of repeated systemic chemotherapy. Histopathological findings including immunohistochemical staining of CK7, CK20, and GATA3 confirmed lymph node metastasis from bladder urothelial carcinoma. The patient has remained recurrence-free to date without any additional postoperative treatment. Although salvage neck dissection could be applied in this case, its clinical benefit in terms of long-term survival is still unknown because of the lack of previous reports of similar cases, and so continuous close follow-up is required.

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A 9-year-old boy was referred to our hospital because of a median cervical mass and sore throat. A diagnosis of papillary thyroid cancer （cT4aN1bM1） was made, and a total thyroidectomy, D3c dissection, and tracheostomy were performed. Intraoperatively, the left recurrent nerve required partial resection due to tumor invasion, and was reconstructed using a nerve regeneration tube for a defect length of 13mm. Excellent postoperative voice function was observed, and postoperative radioiodine therapy markedly reduced the size of the lung metastasis, and the patient is doing well. Although pediatric thyroid cancer is less common, advancement at the time of diagnosis is frequently observed, and there are cases that require recurrent nerve reconstruction as in adult patients. We report our experience of using a nerve regeneration tube for aggressive pediatric thyroid cancer.

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Pseudoaneurysms may occasionally complicate chemoradiotherapy, which is widely used for head and neck cancer. Pseudoaneurysm rupture, known as carotid blowout syndrome （CBS）, is a fatal outcome. However, standard treatment for CBS remains unavailable. We report three cases of a ruptured pseudoaneurysm of the common carotid artery after chemoradiotherapy for hypopharyngeal cancer. All three patients presented with hematemesis, and in order to control this hemorrhage, one underwent total laryngectomy, while the other two underwent pharyngolaryngoesophagectomy.
Cases 1 and 2: Unexpected hemorrhage from the common carotid artery led to intraoperative pseudoaneurysm rupture, and we performed suturing and coil embolization, respectively. Both patients developed postoperative cerebral infarction and were subsequently transferred to another facility in a bedridden state.
Case 3: We performed endovascular therapy as initial treatment. Subsequently, we performed pharyngolaryngoesophagectomy with free jejunal reconstruction and combined resection of the common carotid artery for radical treatment of laryngeal necrosis and prevention of rebleeding. We performed preoperative stroke risk assessment to minimize the risk of cerebral infarction.
Endovascular treatment is commonly used for hemostasis in patients with ruptured pseudoaneurysms. However, studies have reported recurrent bleeding following this treatment. Therefore, pharyngolaryngoesophagectomy and concomitant common carotid artery resection should be performed after endovascular intervention to prevent rebleeding and to address laryngeal necrosis. Preemptive stroke risk assessment can improve treatment outcomes with preservation of activities of daily living.

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Salivary gland secretory carcinoma is a salivary gland malignancy listed in the new WHO classification revised in 2017. In this study, we experienced a case of parotid gland secretory carcinoma with cancerous pleural effusion due to pleural metastasis. Although radical surgery was not indicated, the ETV6-NTRK3 fusion gene was detected in the biopsy specimen, and so Larotrectinib, a tropomyosin receptor kinase inhibitor, was started. In response, tumor shrinkage, a decrease in cancerous pleural effusion, and improvement in subjective symptoms were observed. The medication was continued, and the patient’s disease has not worsened. Larotrectinib was approved for production and marketing in Japan in March 2021, and there is only one report of its use in Japan at the time of writing. This case is considered to be a valuable report of a rapid response to Larotrectinib after initiation of the drug.

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