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

Chikatoshi Katada¹, Manabu Muto², Satoshi Fujii³, Tetsuji Yokoyama⁴, Tomonori Yano⁵, Akihito Watanabe⁶, Toshiro Iizuka⁷, Shigetaka Yoshinaga⁸, Ichiro Tateya⁹, Hiroki Mitani¹⁰, Yuichi Shimizu¹¹, Akiko Takahashi¹², Tomoyuki Kamijo¹³, Noboru Hanaoka¹⁴, Makoto Abe¹⁵, Akihiro Shiotani¹⁶, Koichi Kano¹⁷, Yukinori Asada¹⁸, Tamotsu Matsuhashi¹⁹, Hirohito Umeno²⁰, Kenji Okami²¹, Kenichi Goda²², Shinichiro Hori²³, Yoichiro Ono²⁴, Shuji Terai²⁵, Yasuaki Nagami²⁶, Kenichi Takemura²⁷, Kenro Kawada²⁸, Mizuo Ando²⁹, Naoto Shimeno³⁰, Akihito Arai³¹, Yasutoshi Sakamoto³², Masaaki Ichinoe³³, Tetsuo Nemoto³⁴, Masahiro Fujita³⁵, Hidenobu Watanabe³⁶, Tadakazu Shimoda³⁷, Atsushi Ochiai³⁸, Takakuni Kato³⁹, Ryuichi Hayashi⁴⁰

Affiliations

¹ Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.
² Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
³ Department of Molecular Pathology, Yokohama City University School of Medicine, Yokohama, Japan.
⁴ Department of Health Promotion, National Institute of Public Health, Wako, Japan.
⁵ Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
⁶ Department of Otolaryngology, Keiyukai Sapporo Hospital, Sapporo, Japan.
⁷ Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
⁸ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
⁹ Department of Otolaryngology - Head and Neck Surgery, Kyoto University, Kyoto, Japan.
¹⁰ Department of Head and Neck Oncology, Cancer Institute Hospital, Tokyo, Japan.
¹¹ Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan.
¹² Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan.
¹³ Division of Head and Neck Surgery, Shizuoka Cancer Center, Nagaizumi, Japan.
¹⁴ Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
¹⁵ Department of Gastroenterology and Hepatology, Okayama University Graduate School, Okayama, Japan.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan.
¹⁷ Department of Otorhinolaryngology - Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
¹⁸ Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Japan.
¹⁹ Department of Gastroenterology, Akita University School of Medicine, Akita, Japan.
²⁰ Department of Otolaryngology- Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan.
²¹ Department of Otolaryngology- Head and Neck Surgery, Tokai University, Isehara, Japan.
²² Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
²³ Department of Endoscopy, NHO Shikoku Cancer Center, Matsuyama, Japan.
²⁴ Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan.
²⁵ Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
²⁶ Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.
²⁷ Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
²⁸ Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
²⁹ Department of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
³⁰ Department of Gastroenterology, Kobe City Medical Center General Hospital, Kobe, Japan.
³¹ Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
³² Kitasato Clinical Research Center, Kitasato University School of Medicine, Sagamihara, Japan.
³³ Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan.
³⁴ Department of Diagnostic Pathology, Showa University School of Medicine, Yokohama Northern Hospital, Yokohama, Japan.
³⁵ Department of Clinical Pathology, Sapporo Hokuyu Hospital, Sapporo, Japan.
³⁶ Department of Pathology, Pathology and Cytology Laboratories BML INC, Tokyo, Japan.
³⁷ Department of Diagnostic Pathology, Shizuoka Cancer Center, Nagaizumi, Japan.
³⁸ Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan.
³⁹ Department of Otorhinolaryngology - Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan.
⁴⁰ Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

PMID: 33991076
PMCID: PMC8209601
DOI: 10.1002/cam4.3927

Multicenter Study

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

Chikatoshi Katada et al. Cancer Med. 2021 Jun.

. 2021 Jun;10(12):3848-3861.

doi: 10.1002/cam4.3927. Epub 2021 May 15.

Authors

Affiliations

¹ Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.
² Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
³ Department of Molecular Pathology, Yokohama City University School of Medicine, Yokohama, Japan.
⁴ Department of Health Promotion, National Institute of Public Health, Wako, Japan.
⁵ Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
⁶ Department of Otolaryngology, Keiyukai Sapporo Hospital, Sapporo, Japan.
⁷ Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
⁸ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
⁹ Department of Otolaryngology - Head and Neck Surgery, Kyoto University, Kyoto, Japan.
¹⁰ Department of Head and Neck Oncology, Cancer Institute Hospital, Tokyo, Japan.
¹¹ Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan.
¹² Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan.
¹³ Division of Head and Neck Surgery, Shizuoka Cancer Center, Nagaizumi, Japan.
¹⁴ Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
¹⁵ Department of Gastroenterology and Hepatology, Okayama University Graduate School, Okayama, Japan.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan.
¹⁷ Department of Otorhinolaryngology - Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
¹⁸ Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Japan.
¹⁹ Department of Gastroenterology, Akita University School of Medicine, Akita, Japan.
²⁰ Department of Otolaryngology- Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan.
²¹ Department of Otolaryngology- Head and Neck Surgery, Tokai University, Isehara, Japan.
²² Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
²³ Department of Endoscopy, NHO Shikoku Cancer Center, Matsuyama, Japan.
²⁴ Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan.
²⁵ Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
²⁶ Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.
²⁷ Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
²⁸ Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
²⁹ Department of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
³⁰ Department of Gastroenterology, Kobe City Medical Center General Hospital, Kobe, Japan.
³¹ Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
³² Kitasato Clinical Research Center, Kitasato University School of Medicine, Sagamihara, Japan.
³³ Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan.
³⁴ Department of Diagnostic Pathology, Showa University School of Medicine, Yokohama Northern Hospital, Yokohama, Japan.
³⁵ Department of Clinical Pathology, Sapporo Hokuyu Hospital, Sapporo, Japan.
³⁶ Department of Pathology, Pathology and Cytology Laboratories BML INC, Tokyo, Japan.
³⁷ Department of Diagnostic Pathology, Shizuoka Cancer Center, Nagaizumi, Japan.
³⁸ Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan.
³⁹ Department of Otorhinolaryngology - Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan.
⁴⁰ Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

PMID: 33991076
PMCID: PMC8209601
DOI: 10.1002/cam4.3927

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.

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Conflict of interest statement

Professor Manabu Muto received a joint research fund between Kyoto University and Olympus Corporation out of this study. Dr. Ryuichi Hayashi received a grant from the Japan Agency for Medical Research and Development (Grant No. 19ck0106510h0001). Other authors have not declared a specific grant for this study from any funding agency in the public, commercial, or not‐for‐profit sectors.

Figures

**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

See this image and copyright information in PMC

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical