Transoral surgery for superficial head and neck cancer: National Multi-Center Survey in Japan

Abstract

Head and neck cancers, especially in hypopharynx and oropharynx, are often detected at advanced stage with poor prognosis. Narrow band imaging enables detection of superficial cancers and transoral surgery is performed with curative intent. However, pathological evaluation and real-world safety and clinical outcomes have not been clearly understood. The aim of this nationwide multicenter study was to investigate the safety and efficacy of transoral surgery for superficial head and neck cancer. We collected the patients with superficial head and neck squamous cell carcinoma who were treated by transoral surgery from 27 hospitals in Japan. Central pathology review was undertaken on all of the resected specimens. The primary objective was effectiveness of transoral surgery, and the secondary objective was safety including incidence and severity of adverse events. Among the 568 patients, a total of 662 lesions were primarily treated by 575 sessions of transoral surgery. The median tumor diameter was 12 mm (range 1-75) endoscopically. Among the lesions, 57.4% were diagnosed as squamous cell carcinoma in situ. The median procedure time was 48 minutes (range 2-357). Adverse events occurred in 12.7%. Life-threatening complications occurred in 0.5%, but there were no treatment-related deaths. During a median follow-up period of 46.1 months (range 1-113), the 3-year overall survival rate, relapse-free survival rate, cause-specific survival rate, and larynx-preservation survival rate were 88.1%, 84.4%, 99.6%, and 87.5%, respectively. Transoral surgery for superficial head and neck cancer offers effective minimally invasive treatment. Clinical trials registry number: UMIN000008276.

Keywords: head and neck cancer; larynx preservation; pharyngeal cancer; superficial cancer; transoral surgery.

FIGURE 1

Flow chart of patients and lesions. ^*Seven other sessions for synchronous lesions were performed on another day

FIGURE 2

Cumulative incidence of metachronous cancers and survival rate. A, Cumulative incidence rate of metachronous head and neck cancers. B, Cumulative incidence rate of metachronous cancers arising in other organs. C, Overall survival rate. D, Relapse‐free survival rate. E, Cause‐specific survival rate. F, Larynx‐preservation survival rate. G, Overall survival rates according to the histopathological depth of invasion. H, Relapse‐free survival rates according to the histopathological depth of invasion. I, Cause‐specific survival rates according to the histopathological depth of invasion. J, Overall survival rates according to the T category. K, Relapse‐free survival rates according to the T category