Publications by authors named "Ryuichi Hayashi"

149 Publications

General rules for clinical and pathological studies on oral cancer (2nd edition): a synopsis.

Int J Clin Oncol 2021 Apr 15;26(4):623-635. Epub 2021 Mar 15.

Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.

For doctors and other medical staff treating oral cancer, it is necessary to standardize the basic concepts and rules for oral cancer to achieve progress in its treatment, research, and diagnosis. Oral cancer is an integral part of head and neck cancer and is treated in accordance with the general rules for head and neck cancer. However, detailed rules based on the specific characteristics of oral cancer are essential. The objective of this article was to contribute to the development of the diagnosis, treatment, and research of oral cancer, based on the correct and useful medical information of clinical, surgical, pathological, and imaging findings accumulated from individual patients at various institutions. Our general rules were revised as the UICC was revised for the 8th edition and were published as the Japanese second edition in 2019. In this paper, the English edition of the "Rules" section is primarily presented.
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http://dx.doi.org/10.1007/s10147-020-01812-9DOI Listing
April 2021

Surgical Outcome of Pharyngocutaneous Fistula After Total Laryngectomy: A Retrospective Study.

Ann Plast Surg 2021 Mar 4. Epub 2021 Mar 4.

From the Departments of Plastic and Reconstructive Surgery Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Background: The management of pharyngocutaneous fistula is challenging. We typically treat postlaryngectomy pharyngocutaneous fistulas with a pedicled pectoralis major flap transfer. This study analyzed the outcomes of our surgical treatments for pharyngocutaneous fistula to propose considerations for surgical strategies.

Methods: This retrospective review included all patients who underwent surgical repair of a postlaryngectomy pharyngocutaneous fistula at the National Cancer Center Hospital East in Kashiwa, Japan, from January 2005 to December 2019.

Results: The final analysis included 33 cases (median age, 71 years). Twenty-two cases had a history of radiotherapy to the head and neck region. Wound closures were performed with a pedicled pectoralis major musculocutaneous flap (n = 26) or pedicled pectoralis major muscle flap (n = 7). In 1 case, a deltopectoral flap was combined with the pectoralis major musculocutaneous flap. The median total operation time was 236 minutes, the median blood loss during surgery was 144 mL, and the median hospital stay after the reconstructive surgery was 39 days. Minor leakage occurred in 19 cases, and major leakage occurred in 2 cases. The fistula was finally cured successfully in 31 cases. We compared the outcomes in patients with leakage after surgical repair to those in patients without leakage after surgical repair to determine the risk factors for leakage after surgical repair of a pharyngocutaneous fistula. Five patients in the nonleakage group and 17 in the leakage group had a history of preoperative radiation (P = 0.052). The median preoperative blood values in the nonleakage and leakage groups were as follows: albumin, 3.6 and 3.2 g/dL (P = 0.061), and C-reactive protein, 2.36 and 6.77 mg/dL (P = 0.031), respectively. The time between the occurrence of the fistula and reconstructive surgery was 32 and 9 days in the nonleakage and leakage groups, respectively (P = 0.009).

Conclusions: Our surgical treatment for postlaryngectomy pharyngocutaneous fistula succeeded in 31 of 33 cases (94%). This study demonstrated that pedicled pectoralis major flap transfer is useful for the treatment of postlaryngectomy pharyngocutaneous fistula.
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http://dx.doi.org/10.1097/SAP.0000000000002769DOI Listing
March 2021

Induction chemotherapy in locally advanced squamous cell carcinoma of the head and neck.

Jpn J Clin Oncol 2021 Feb;51(2):173-179

Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.

In order to maximize the benefit of induction chemotherapy, practice based on a comprehensive interpretation of a large number of clinical trials, as in this review, is essential. The standard treatment for locally advanced squamous cell carcinoma of the head and neck is surgery or chemoradiation. However, induction chemotherapy followed by (chemo) radiotherapy may be used in some circumstances. Although many clinical trials of induction chemotherapy have been conducted, a rationale other than to preserve the larynx is still controversial. Selection of this modality should therefore be made with care. The current standard regimen for induction chemotherapy is docetaxel, cisplatin and 5-FU, but concerns remain about toxicity, cost and the duration of treatment. Regarding treatment after induction chemotherapy, it is also unclear whether radiation alone or chemoradiation is the better option. Furthermore, there is no answer as to what drugs should be used in combination with radiation therapy after induction chemotherapy. Several new induction chemotherapy treatment developments are currently underway, and future developments are expected. This review article summarizes the current position of induction chemotherapy for head and neck squamous cell carcinoma, based on the evidence produced to date, and discusses the future prospects for this treatment.
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http://dx.doi.org/10.1093/jjco/hyaa220DOI Listing
February 2021

Multi-institutional Survey of Squamous Cell Carcinoma of the External Auditory Canal in Japan.

Laryngoscope 2021 03 30;131(3):E870-E874. Epub 2020 Jul 30.

Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Objectives: This study aimed to evaluate the efficacy of chemoradiotherapy (CRT) for patients with advanced cancer of the external auditory canal (EAC) by analyzing the outcome of the patients.

Methods: This is a multi-institutional retrospective survey, and we reviewed the medical records of the subjects. A total of 181 patients with tumor (T)3 or T4 tumor in 17 institutions were enrolled. Further analysis was performed for 74 patients who underwent CRT under curative intent.

Results: Overall 5-year survival rates of the patients who underwent CRT (n = 74) were 54.6%. Those of the patients who underwent CRT with modified TPF (docetaxel, cisplatin [CDDP], and 5-fluorouracil) regimen (n = 50) and CRT with CDDP regimens (n = 24) were 64.4% and 36.7%, respectively. Significant differences were observed between these two groups.

Conclusion: Given the tendency that head and neck surgeons prefer CRT for advanced larger cancer of the EAC, CRT for advanced EAC cancer using the modified TPF regimen showed good clinical outcomes.

Level Of Evidence: 4 Laryngoscope, 131:E870-E874, 2021.
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http://dx.doi.org/10.1002/lary.28936DOI Listing
March 2021

Extent of salvage neck dissection following chemoradiation for locally advanced head and neck cancer.

Head Neck 2021 Feb 1;43(2):413-418. Epub 2020 Oct 1.

Division of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan.

Background: Salvage neck dissection (ND) is the only treatment modality for persistent or recurrent nodal disease after chemoradiotherapy (CRT) for locally advanced head and neck cancer. However, the optimal extent of ND at salvage surgery after definitive CRT is controversial.

Methods: Our salvage ND procedure is targeted extirpation of nodal disease with resection of only involved areas of nonlymphatic structures. A retrospective analysis of the data indicated a total of 28 targeted NDs performed in 28 patients following definitive CRT. The efficacy of targeted ND was evaluated based on survival rate, regional control rate, complications, and shoulder syndromes.

Results: Over a median follow-up period of 30 months, cervical disease recurred in 7 patients but did not lead to death, and 2 patients died of pulmonary metastasis. The 3-year disease-specific survival rate was 66%.

Conclusion: The targeted ND procedure was effective as an intervention for patients with cervical disease recurrence (149/150).
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http://dx.doi.org/10.1002/hed.26494DOI Listing
February 2021

Immunotherapy for squamous cell carcinoma of the head and neck.

Jpn J Clin Oncol 2020 Sep;50(10):1089-1096

Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Squamous cell carcinoma of the head and neck is characterized by an immunosuppressive environment and evades immune responses through multiple resistance mechanisms. A breakthrough in cancer immunotherapy employing immune checkpoint inhibitors has evolved into a number of clinical trials with antibodies against programmed cell death 1 (PD-1), its ligand PD-L1 and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) for patients with squamous cell carcinoma of the head and neck. CheckMate141 and KEYNOTE-048 were practice-changing randomized phase 3 trials for patients with platinum-refractory and platinum-sensitive recurrent or metastatic squamous cell carcinoma of the head and neck, respectively. Furthermore, many combination therapies using anti-CTLA-4 inhibitors, tyrosine kinase inhibitors and immune accelerators are currently under investigation. Thus, the treatment strategy of recurrent or metastatic squamous cell carcinoma of the head and neck is becoming more heterogeneous and complicated in the new era of individualized medicine. Ongoing trials are investigating immunotherapeutic approaches in the curative setting for locoregionally advanced disease. This review article summarizes knowledge of the role of the immune system in the development and progression of squamous cell carcinoma of the head and neck, and provides a comprehensive overview on the development of immunotherapeutic approaches in both recurrent/metastatic and locoregionally advanced diseases.
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http://dx.doi.org/10.1093/jjco/hyaa139DOI Listing
September 2020

Optimization of therapeutic strategy for p16-positive oropharyngeal squamous cell carcinoma: Multi-institutional observational study based on the national Head and Neck Cancer Registry of Japan.

Cancer 2020 Sep 10;126(18):4177-4187. Epub 2020 Jul 10.

Department of Otorhinolaryngology, Kindai University Nara Hospital, Nara, Japan.

Background: Although the American Joint Committee on Cancer TNM classification has been amended to include human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) as an independent entity, to the authors' knowledge the optimized de-escalating treatment modality has not been established to date.

Methods: The authors conducted a retrospective, nationwide, observational study in patients with HPV-related OPSCC who were treated from 2011 to 2014 in Japan to determine the best treatment modality.

Results: A total of 688 patients who were newly diagnosed with HPV-related OPSCC who were treated with curative intent at 35 institutions and had coherent clinical information and follow-up data available were included in the current study. In patients with T1-T2N0 disease (79 patients), both the 3-year recurrence-free survival and overall survival (OS) rates were 100% in the group treated with radiotherapy (RT) as well as the group receiving concurrent chemoradiotherapy (CCRT). The 3-year OS rates were 94.4% (for patients with T1N0 disease) and 92.9% (for patients with T2N0 disease) among the patients treated with upfront surgery. In patients with stage I to stage II HPV-related OPSCC, the 5-year recurrence-free survival and OS rates were 91.4% and 92%, respectively, in the patients treated with CCRT with relatively high-dose cisplatin (≥160 mg/m ; 114 patients) and 74.3% and 69.5%, respectively, in the patients treated with low-dose cisplatin (<160 mg/m ; 17 patients).

Conclusions: Despite it being a retrospective observational trial with a lack of information regarding toxicity and morbidity, the results of the current study demonstrated that patients with T1-T2N0 HPV-related OPSCC could be treated with RT alone because of the equivalent outcomes of RT and CCRT, and patients with stage I to stage II HPV-related OPSCC other than those with T1-T2N0 disease could be treated with CCRT with cisplatin at a dose of ≥160 mg/m .
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http://dx.doi.org/10.1002/cncr.33062DOI Listing
September 2020

Artificial intelligence system for detecting superficial laryngopharyngeal cancer with high efficiency of deep learning.

Head Neck 2020 09 16;42(9):2581-2592. Epub 2020 Jun 16.

Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.

Background: There are no published reports evaluating the ability of artificial intelligence (AI) in the endoscopic diagnosis of superficial laryngopharyngeal cancer (SLPC). We presented our newly developed diagnostic AI model for SLPC detection.

Methods: We used RetinaNet for object detection. SLPC and normal laryngopharyngeal mucosal images obtained from narrow-band imaging were used for the learning and validation data sets. Each independent data set comprised 400 SLPC and 800 normal mucosal images. The diagnostic AI model was constructed stage-wise and evaluated at each learning stage using validation data sets.

Results: In the validation data sets (100 SLPC cases), the median tumor size was 13.2 mm; flat/elevated/depressed types were found in 77/21/2 cases. Sensitivity, specificity, and accuracy improved each time a learning image was added and were 95.5%, 98.4%, and 97.3%, respectively, after learning all SLPC and normal mucosal images.

Conclusions: The novel AI model is helpful for detection of laryngopharyngeal cancer at an early stage.
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http://dx.doi.org/10.1002/hed.26313DOI Listing
September 2020

Relationship between the microvascular patterns observed by magnifying endoscopy with narrow-band imaging and the depth of invasion in superficial pharyngeal squamous cell carcinoma.

Esophagus 2021 Jan 8;18(1):111-117. Epub 2020 Jun 8.

Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.

Background: Prediction of the invasive depth is the objective of endoscopic observation for digestive cancer. In superficial esophageal cancer, a close relationship between microvascular patterns observed by magnifying endoscopy with narrow-band imaging (M-NBI) and pathological depth of invasion is well known. The ability of M-NBI to predict the invasion depth in superficial pharyngeal squamous cell carcinoma (SPSCC) has been seldom evaluated. This study aimed to clarify the relationship between the microvasculature patterns and pathological depth in SPSCC.

Methods: SPSCC lesions evaluated with M-NBI followed by endoscopic resection were analyzed between April 2010 and March 2017. Endoscopic images were classified as microvasculature tumor types B1, B2, and B3 according to the Japan Esophageal Society classification. The pathological depth of invasion was described as either squamous cell carcinoma in situ (Tis) or invasive subepithelial cancer, and the tumor thickness of all lesions was examined. Data were analyzed using the unpaired t, χ, or Mann-Whitney U test.

Results: Type B1 and type B2/B3 (35/3) microvessels were found in 180 lesions (82%) and 39 (18%), respectively. Of the flat lesions, 115 (83%) were classified as Tis and 23 (17%) as subepithelial cancer. Positive and negative predictive values of the B1 vessels were 77% and 82%, respectively. Additional analysis showed that the positive predictive value of the B1 vessels for the flat-type lesions was 87%; the negative predictive value for the elevated lesions was 93%.

Conclusions: Microvascular patterns observed by M-NBI are an important factor in predicting the pathological depth of invasion.
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http://dx.doi.org/10.1007/s10388-020-00754-5DOI Listing
January 2021

Salvage Reconstructive Surgery During Nivolumab Therapy for a Patient With Hypopharyngeal Cancer.

Clin Med Insights Case Rep 2020 18;13:1179547620908854. Epub 2020 Apr 18.

Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Objectives: Nivolumab, a fully IgG4-programmed death-1 inhibitor antibody, led to improved overall survival compared with single-agent therapy in patients with platinum-refractory recurrent head and neck cancers. In general, nivolumab is used in inoperable patients. To the best of our knowledge, there have been no reports of salvage surgery during nivolumab therapy for patients with head and neck cancer. We report the case of a woman treated with salvage reconstructive surgery during nivolumab therapy.

Method: Case report and literature review.

Results: The patient underwent nivolumab therapy for recurrent primary and neck disease after induction chemotherapy, followed by concurrent chemoradiation therapy. The neck disease shrunk, whereas the primary disease temporarily shrunk but later progressed again. Recurrent primary disease led to a narrowing of her airway, and she required airway management. We performed total pharyngolaryngectomy with free jejunal reconstruction, and her quality of life improved. The surgery was performed without complications and the postoperative course was uneventful. She was discharged postoperative day 18 with oral intake function and a safer airway.

Conclusion: As far as we know, this is the first report of salvage surgery during nivolumab therapy for patients with head and neck cancer. The salvage reconstructive surgery in this case proceeded uneventfully.
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http://dx.doi.org/10.1177/1179547620908854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169354PMC
April 2020

Extra-nodal extension in head and neck cancer: how radiologists can help staging and treatment planning.

Jpn J Radiol 2020 Jun 24;38(6):489-506. Epub 2020 Feb 24.

Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.

Extranodal extension (ENE) is a significant prognostic factor in p16-negative head and neck squamous-cell carcinoma and is classified as N3b by the American Joint Committee on Cancer 8th edition. While most previous radiological studies have focused on the diagnostic performance of pathological ENE, radiologists should be able to provide more clinically relevant information on this entity. The purpose of this article is to review the clinical implications of ENE, to describe key imaging features of ENE with clinical and histopathological correlations and to discuss evaluation of ENE for clinical staging, treatment planning, and predicting the response to treatment. First, we discuss the basics of ENE, including definitions of pathological and clinical ENE and its association with imaging findings. Second, we describe the ENE extension pattern at each location according to level system. The crucial structures determining the choice of treatment include the deep fascia in the deep cervical layer, internal and common carotid arteries, and mediastinal structures. Invasion of the muscles, internal jugular vein, nerves, or mandible also affect the surgical procedure. Finally, we discuss assessment of nodal metastasis after chemoradiotherapy.
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http://dx.doi.org/10.1007/s11604-020-00929-1DOI Listing
June 2020

Efficacy and safety of accelerated fractionated radiotherapy without elective nodal irradiation for T3N0 glottic cancer without vocal cord fixation.

Head Neck 2020 08 7;42(8):1775-1782. Epub 2020 Feb 7.

Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan.

Background: The purpose of this study was to evaluate accelerated fractionated radiotherapy (AFRT) without elective nodal irradiation (ENI) for T3N0 glottic cancer (GC) without vocal cord fixation, especially in comparison with chemoradiotherapy (CRT) and hyperfractionated radiotherapy (HFRT) both of which included ENI.

Methods: The medical charts of patients with T3N0GC without cord fixation received definitive radiotherapy between June 2005 and March 2018 were reviewed.

Results: A total of 74 patients were analyzed. After a median follow-up time of 46 months (range, 12-141), 3-year local failure in AFRT/CRT/HFRT (n = 41/10/23) was 10%/20%/26%, 3-year regional failure 6%/0%/9%, 3-year progression-free survival 71%/69%/74%, and 3-year overall survival 77%/100%/87%. There were no significant differences among three groups in recurrence or survival. Grade 3 adverse events (AEs) were noted in 5/2/8 patients (12%/20%/35%) in AFRT/CRT/HFRT, respectively. There were no Grade 4/5 AEs.

Conclusions: AFRT without ENI is an effective and feasible treatment for T3N0GC without cord fixation.
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http://dx.doi.org/10.1002/hed.26092DOI Listing
August 2020

Comparison of salvage surgery for recurrent or residual head and neck squamous cell carcinoma.

Jpn J Clin Oncol 2020 Mar;50(3):288-295

Departments of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Objective: Concomitant chemoradiation therapy is a standard treatment for head and neck cancer. Thus, salvage surgery has become a necessary treatment. The aim of the study was to evaluate the results of salvage surgery by each site of the head and neck, especially the oropharynx, hypopharynx and larynx.

Methods: This was a retrospective, single-institute study. The primary endpoint was overall survival. Secondary endpoints were disease-free survival, the locoregional control rate after salvage surgery, the indication rate for salvage surgery, the reasons for contraindications to salvage surgery, the post-operative complication rate and the predictors of survival.

Results: Three-year overall survival after salvage surgery was 58.8% in the salvage surgery group and 8.59% in the other treatment group (P < 0.0001). Regarding overall survival and disease-free survival after salvage surgery, there was no difference among sites. Regarding locoregional control rate among sites, there was no significant difference. The oropharyngeal cancer group had the lowest rate of salvage primary resection. Surgical margin and local and regional recurrence or residual disease were predictors on univariate and multivariate analyses.

Conclusions: Salvage surgery is effective for recurrent or residual cases after concomitant chemoradiation therapy. For oropharyngeal cancer, local control is important, and for oropharyngeal cancer and hypopharyngeal cancer, distant metastasis is important.
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http://dx.doi.org/10.1093/jjco/hyz176DOI Listing
March 2020

Nutritional support dependence after curative chemoradiotherapy in head and neck cancer: supplementary analysis of a phase II trial (JCOG0706S1).

Jpn J Clin Oncol 2019 Dec;49(11):1009-1015

Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.

Objectives: To explore the risk factors of laryngo-esophageal dysfunction-free survival and nutritional support dependence over 12 months in patients with unresectable locally advanced head and neck carcinomas who received chemoradiotherapy in a phase II trial of JCOG0706 (UMIN000001272).

Methods: Forty-five patients received radiation therapy for a total of 70 Gy/35fr concurrently with S-1 and cisplatin. Risk factors of laryngo-esophageal dysfunction-free survival and nutritional support dependence over 12 months were analyzed using Cox regression models and logistic regression models, respectively, with consideration to patient laboratory data just before chemoradiotherapy. Radiation fields were reviewed to analyze the relationship between the extent of the irradiated field and functional outcome.

Results: With a median follow-up period of 3.5 years, 3-year laryngo-esophageal dysfunction-free survival was 48.9%. For laryngo-esophageal dysfunction-free survival, hazards ratio of 2.35 in patients with nutritional support at registration (vs. without nutritional support; 95% confidence interval 0.96-5.76). For nutritional support dependence over 12 months, odds ratio was 6.77 in patients with hemoglobin less than the median of 13.4 g/dl (vs. higher than or equal to the median; 95% confidence interval 1.24-36.85) and was 6.00 in patients with albumin less than the median of 3.9 g/dl (vs. higher than or equal to the median; 95% confidence interval 1.11-32.54). Primary sites in disease-free patients with nutritional support dependence over 12 months were the oropharynx (N = 2) or hypopharynx (N = 1), and all pharyngeal constrictor muscles were included in irradiated fields with a curative dose.

Conclusions: This supplementary analysis showed that pretreatment severe dysphagia requiring nutritional support, anemia and hypoalbuminemia might have a negative prognostic impact on long-term functional outcomes after curative chemoradiotherapy in head and neck cancer.
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http://dx.doi.org/10.1093/jjco/hyz121DOI Listing
December 2019

Clavien-Dindo classification for grading complications after total pharyngolaryngectomy and free jejunum transfer.

PLoS One 2019 12;14(9):e0222570. Epub 2019 Sep 12.

Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Background: The frequency of postoperative complications is used as an indicator of surgical quality; however, comparison of outcomes is hampered by a lack of agreement on the definition of complications and their severity. A standard grading system for surgical complications is necessary to improve the quality of clinical research and reporting in head and neck reconstruction.

Methods: The aim of this study was to compare postoperative morbidity after microvascular head and neck reconstruction between patients with versus without a history of prior radiation therapy (RT) by using the Clavien-Dindo classification. A group of 274 patients was divided into two cohorts based on the history of prior RT: the RT group included 79 patients and the non-RT group included 195 patients. Postoperative (30-day) complications were compared between the groups with a nonstandardized evaluation system and the Clavien-Dindo classification.

Results: The grades of complications according to the Clavien-Dindo classification were significantly higher in the RT group than in the non-RT group. The frequency of postoperative complications did not differ significantly between the groups according to the nonstandardized evaluation system.

Conclusions: The Clavien-Dindo classification could serve as a useful, highly objective tool for grading operative morbidity after microvascular head and neck reconstruction when comparing similar defects and methods of reconstruction. Widespread use of the Clavien-Dindo classification system would allow adequate comparisons of surgical outcomes among different surgeons, centers, and therapies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222570PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6742376PMC
March 2020

Frequency and predictors of detecting early locoregional recurrence/disease progression of oral squamous cell carcinoma with high-risk factors on imaging tests before postoperative adjuvant radiotherapy.

Int J Clin Oncol 2019 Oct 9;24(10):1182-1189. Epub 2019 Jul 9.

Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.

Background: To clarify the frequency and predictors of detecting early locoregional recurrence/disease progression (LR/DP) during the interval between surgery and postoperative adjuvant radiotherapy with/without chemotherapy in patients with oral squamous cell carcinoma.

Methods: Data on 65 patients who had undergone the initial radical surgery for previously untreated oral squamous cell carcinoma which were scheduled to receive adjuvant radiotherapy with/without chemotherapy were reviewed.

Results: Of the 65 patients, 63 (97%) were margin-positive/close and/or extracapsular extension-positive (hereinafter, high-risk factors). Eighteen (28%) patients had abnormal findings suggestive of LR/DP on postoperative imaging. Fifteen (23%) patients were diagnosed with LR/DP and treatment policy was changed. Univariate and multivariate analyses revealed higher frequencies of abnormal findings suggestive of LR/DP (univariate/multivariate analysis, p = 0.020/0.036), diagnosing of LR/DP, and changing the treatment policy (univariate/multivariate analysis, p = 0.042/0.046), among the patients who underwent postoperative diagnostic imaging tests or radiotherapy-planning contrast-enhanced (CE) CT without diagnostic imaging tests as compared with those who underwent radiotherapy-planning non-CECT without such tests.

Conclusion: The frequency of detecting of early LR/DP before postoperative adjuvant treatment in oral squamous cell carcinoma patients with high-risk factors was high. Furthermore, postoperative diagnostic imaging tests and radiotherapy-planning CECT may be useful to detect early LR/DP in oral squamous cell carcinoma patients before postoperative adjuvant therapy.
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http://dx.doi.org/10.1007/s10147-019-01479-xDOI Listing
October 2019

Treatment results of 99 patients undergoing open partial hypopharyngectomy with larynx preservation.

Jpn J Clin Oncol 2019 Oct;49(10):919-923

Department of Plastic and Reconstructive Surgery National Cancer Center Hospital East, Chiba, Japan.

Objective: Hypopharyngeal cancers frequently go undetected until advanced stages. However, recent advances in endoscopic technology have enabled earlier detection of hypopharyngeal cancer. We evaluated the effectiveness of larynx-preserving surgery for hypopharyngeal cancer.

Methods: We retrospectively analyzed 99 patients with hypopharyngeal squamous cell carcinoma who underwent partial hypopharyngectomy with larynx preservation between September 1992 and December 2009 at the National Cancer Center Hospital East. Of these, 91 patients underwent larynx-preserving surgery as initial treatment; eight patients underwent salvage surgery for recurrent disease after previous radiotherapy. Also, 9 of our patients had undergone previous radiotherapy in the head and neck for a different cancer. Before surgery, the TNM stage and tumor location was recorded. Free-flap reconstruction was performed in 60 patients, while the hypopharyngeal mucosa was closed without a free flap in 39 patients.

Results: The 5-year overall survival rate in our cohort was 66.9%, and 59 patients are currently alive without recurrence. Thirty-three patients died due to primary recurrence (n = 5), regional recurrence (n = 10), distant metastasis (n = 9), postoperative death (n = 1), and unrelated disease (n = 8). Laryngeal function could not be preserved in 19 patients, 2 of whom had undergone previous radiotherapy, and 7 of whom had undergone both previous radiotherapy and other salvage surgeries.

Conclusion: Partial hypopharyngectomy can preserve laryngeal function in patients with pharyngeal cancer with careful patient selection.
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http://dx.doi.org/10.1093/jjco/hyz091DOI Listing
October 2019

A review of head and neck cancer staging system in the TNM classification of malignant tumors (eighth edition).

Jpn J Clin Oncol 2019 Jul;49(7):589-595

Department of Head and Neck Surgery, National Cancer Center Hospital East, Japan.

A number of major modifications were made to the classification of head and neck carcinomas in the eighth edition of the American Joint Committee on Cancer, Cancer Staging Manual and Union for International Cancer Control TNM classification of Malignant Tumors. These modifications were aimed at improving the prognosis prediction accuracy of the system. In this article, we review the new edition of the TNM classification system. Among the several changes in the new system, a separate algorithm for p16-positive oropharyngeal carcinoma was included, as were new chapters on 'Head and Neck Skin Carcinoma' and 'Unknown Primary Carcinoma-Cervical Nodes.' Changes to Tumor (T) classification were made by introducing the depth of invasion of oral carcinoma, whereas changes to Node (N) classification were made by adding extra-nodal extension. It is believed that these changes will help improve the accuracy of the system in the prediction of prognosis. However, it is necessary to verify their validity through further clinical research.
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http://dx.doi.org/10.1093/jjco/hyz052DOI Listing
July 2019

Stripped Mesenteric Flap: A Novel Option for Preventing Anastomotic Leakage in Circumferential Pharyngeal Reconstruction.

Plast Reconstr Surg Glob Open 2018 Nov 15;6(11):e2014. Epub 2018 Nov 15.

Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Reconstruction of a circumferential pharyngeal defect with a free jejunal flap is a well-established procedure. However, anastomotic leakage often occurs, which can lead to abscess formation, pharyngocutaneous fistula formation, and carotid rupture. Previous reports have described covering the anastomotic site with a mesenteric flap to prevent anastomotic leakage. However, the mesentery is covered by a serosal membrane, which interferes with adhesion and vascular communication. Therefore, we stripped off the serosal membrane to accelerate adhesion to the anastomotic site. We retrospectively studied patients who had a history of radiotherapy and who had received a stripped mesenteric flap in a circumferential pharyngeal reconstruction procedure. We collected the following data: operative time, blood loss, postoperative complications, interval to resumption of oral intake, and duration of hospital stay. We obtained data for 11 patients. The jejunal flap failed in one patient because of arterial thrombosis. One of the other 10 patients developed anastomotic leakage caused by congested mucous membrane necrosis. The patient was treated conservatively and showed no clinical symptoms of infection or inflammation. The 9 remaining patients had no anastomotic leakage. In the present series, although anastomotic leakage was observed in one of 10 patients who underwent circumferential pharyngeal reconstruction using a stripped mesenteric flap, the severity of the leakage was minimized.
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http://dx.doi.org/10.1097/GOX.0000000000002014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414107PMC
November 2018

The role of elective neck dissection for cT4aN0 glottic squamous cell carcinoma.

Jpn J Clin Oncol 2019 Jun;49(6):525-528

Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.

Objective: The indication for elective neck dissection for patients with clinically T4aN0 (cT4aN0) glottic cancer is not established. The objective of this study was to evaluate the role of elective neck dissection for patients with cT4aN0 glottic cancer.

Methods: We assessed patients with cT4aN0 laryngeal squamous cell carcinoma who underwent total laryngectomy between 1998 and 2014 and conducted a retrospective analysis. We considered occult neck metastasis positive when confirmed by histological analysis. When patients with late neck metastases did not undergo therapeutic neck dissection, the presence of occult neck metastasis was judged on the basis of computed tomography. The validity of elective neck dissection for patients with cT4aN0 glottic cancer was assessed from comparisons the rates of occult neck metastases of supraglottic and subglottic cancers, which are generally recommended for elective neck dissection. The distribution of occult neck metastases in glottic cancer is described according to nodal levels.

Results: The rate of occult neck metastasis of cT4aN0 laryngeal cancer was 36% (14/39). There were no significant differences among the rates of glottic 7/21 (33%), supraglottic 3/8 (38%) and subglottic 4/10 (40%) cancers. Patients with glottic cancer did not have bilateral Level IIB and ipsilateral Level IV metastasis. One patient had contralateral Level IV metastasis. The metastases rates of ipsilateral Levels IIA, III, and VI were >10%.

Conclusions: We think that elective neck dissection is valid for cT4aN0 glottic cancer. Ipsilateral Levels IIA, III and VI should be dissected. The omission of neck dissection for bilateral Levels IIB and IV can be considered when there is a need to avoid complications.
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http://dx.doi.org/10.1093/jjco/hyz022DOI Listing
June 2019

Surgical management around the paratracheal area of hypopharyngeal cancer.

Jpn J Clin Oncol 2019 May;49(5):452-457

Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Objective: We aimed to clarify the suitable surgical management around the paratracheal area of patients who undergo total pharyngolaryngectomy based on the pathological results of hypopharyngeal cancer.

Methods: The study was conducted under a multicenter, retrospective observational design in Japan. We analyzed histopathological paratracheal lymph node metastasis and thyroid invasion, and recurrence around the paratracheal area for 184 patients who underwent initial surgery among 280 participants.

Results: There were significant differences in the frequency of metastasis to paratracheal lymph nodes as cN advances (P = 0.0344) and cT advances (P = 0.00028). By subsite, the paratracheal lymph node metastasis ratio was 22/130 patients (16.9%) in piriform sinus (PS), 8/32 (25.0%) in PW, 5/22 (22.7%) in PC and 10/17 (58.8%) in cervical esophagus (Ce+). The ratio of cases with bilateral paratracheal metastasis tended to be higher in cN2c, posterior wall (PW) and postcricoid (PC). Invasion to the thyroid was histopathologically confirmed in 16/184 patients (8.7%). Invasion from the primary lesion was in 15 patients.

Conclusion: This study indicates that it is better for patients with advanced hypopharyngeal cancer at minimum undergo ipsilateral paratracheal lymph node dissection. Tumor subsite of PW, PC or cN2c disease or disease extending to the Ce+ should be treated with bilateral paratracheal neck dissection. In order to more reliably perform paratracheal dissection, there is also an option to resect the thyroid lobe in the range of dissection. Preservation of the thyroid gland can be considered if invasion into the thyroid gland has been clearly ruled out.
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http://dx.doi.org/10.1093/jjco/hyz019DOI Listing
May 2019

Controversies in relation to neck management in N0 early oral tongue cancer.

Jpn J Clin Oncol 2019 Apr;49(4):297-305

Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan.

The standard local treatment for early-stage tongue cancer with no clinical lymph node metastases is partial glossectomy. The frequency of occult lymph node metastasis is ~20-30%. Thus, whether prophylactic neck dissection with glossectomy or glossectomy alone should be performed has been a controversial issue since the 1980s. Both treatments have advantages and disadvantages; however, especially in cases involving prophylactic neck dissection, surgical invasion and complications including the cosmetic disadvantage caused by neck skin incision, accessory nerve paralysis or facial nerve (mandibular marginal branch) paralysis, stiffness of the shoulder or neck and a feeling of neck tightness have been considered issues that could be solved by providing less-invasive treatment to the 70-80% of patients without occult lymph node metastasis. A more accurate preoperative diagnosis and strict follow-up are required to provide minimally invasive treatment while ensuring the therapeutic effect. It is also necessary to narrow down the target based on the risk-benefit balance. The depth of invasion should be considered in cases involving oral cavity malignancies. This was also taken into account in recent revisions of eighth edition of the TNM Classification of Malignant Tumors and it is an important factor for N0 neck management. This review article summarizes previous and recent reports on neck management, focusing on the risk-benefit and future perspectives of the diagnosis and treatment of early-stage oral tongue cancer. This effort is an attempt to establish treatment from the patient's point of view, with the patient's quality of life taken into account.
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http://dx.doi.org/10.1093/jjco/hyy196DOI Listing
April 2019

Radiologic Criteria in Predicting Pathologic Less Invasive Lung Cancer According to TNM 8th Edition.

Clin Lung Cancer 2019 03 15;20(2):e163-e170. Epub 2018 Nov 15.

Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Purpose: The Japan Clinical Oncology Group Study 0201 has proposed radiologic criteria on thin-slice computed tomography to diagnose pathologic less invasive lung adenocarcinoma that could be a candidate for sublobar resection based on the previous tumor, node, metastasis classification system (TNM). The aim of this study was to propose the new radiologic criteria for predicting pathologic less invasive cancer according to the 8th edition TNM.

Patients And Methods: We analyzed 744 patients who had peripheral clinical Tis-T1cN0M0 non-small-cell lung cancer of 3 cm or less and underwent complete resection by lobectomy from 2003 to 2011. We defined lung cancer with no nodal involvement and no vessel invasion pathologically as a pathologic less invasive cancer and investigated the radiologic criteria on the basis of the solid component size and by the consolidation-to-tumor (C/T) ratio (calculated with the maximum solid component diameter divided by the maximum tumor diameter) by using preoperative thin-slice computed tomography to predict them with a specificity of 97% or more, and evaluated overall survival.

Results: Patients with clinical Tis/T1mi/T1a disease had no pathologic invasive cancer except for one patient (specificity, 99%). From the investigation with the C/T ratio, only the criterion of C/T ratio 0.5 or less met the standard (specificity, 100%). The final specificity after combining these criteria was 99.6%, and they showed excellent prognosis (5-year overall survival rate, 96.2%).

Conclusion: Lung cancer with clinical Tis/T1mi/T1a or a C/T ratio of 0.5 or less can be completely cured by sublobar resection with sufficient margin because of its less invasive nature pathologically.
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http://dx.doi.org/10.1016/j.cllc.2018.11.001DOI Listing
March 2019

Clinical impact of cachexia in unresectable locally advanced head and neck cancer: supplementary analysis of a phase II trial (JCOG0706-S2).

Jpn J Clin Oncol 2019 Jan;49(1):37-41

Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.

Objectives: To evaluate the clinical impact of cachexia, defined by the combination of albumin and C-reactive protein levels, in patients with unresectable locally advanced head and neck squamous cell carcinomas who received chemoradiotherapy in a phase II trial of JCOG0706.

Methods: Forty-five patients received radiation for a total of 70 Gy/35fr concurrently with S-1 and cisplatin. The present analysis was conducted in 44 patients with available data. The association between treatment efficacy and cachexia was investigated. Pretreatment cachexia was defined as a serum albumin level of less than 3.5 mg/dl and C-reactive protein level of more than 0.5 mg/dl.

Results: Among the 44 patients, 5 patients had cachexia. On comparison with the cachexic and non-cachexic patients, the percentage of clinical complete remission (20% vs 72%), time to treatment failure at 3 years, (20% vs 53%) and proportion of treatment completion (20% vs 79%) were statistically worse in the cachexic patients, while overall survival, progression-free survival and local progression-free survival at 3 years tended to be worse in cachexic patients.

Conclusions: This supplementary analysis from a prospective study suggests that a pretreatment status of cancer cachexia is a prognostic factor for treatment outcomes and compliance in patients with locally advanced head and neck squamous cell carcinomas treated with chemoradiotherapy, and a candidate stratification factor in future prospective trials in this population.
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http://dx.doi.org/10.1093/jjco/hyy145DOI Listing
January 2019

Randomized phase III study to evaluate the value of omission of prophylactic neck dissection for stage I/II tongue cancer: Japan Clinical Oncology Group study (JCOG1601, RESPOND).

Jpn J Clin Oncol 2018 Dec;48(12):1105-1108

Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan.

For stage I/II tongue cancer patients, it is controversial whether prophylactic neck dissection should be performed with partial glossectomy. Based on the evidence of the primary tumor's depth of invasion as a predictive factor of occult lymph node metastases and a prognostic factor of disease-free survival, randomized phase III trial was initiated in November 2017 to evaluate the omission value for prophylactic neck dissection for stage I/II tongue cancer with 3-10 mm of depth of invasion. In 5 years, 440 patients will be accrued from 28 institutions. The primary end point of the study is the overall survival, whereas the secondary end points are relapse-free survival, local relapse-free survival, proportion of unresectable relapse and of cervical lymph node relapse, post-operative function (paralysis of the accessory and facial nerves and subjective symptoms) and adverse events. This trial has been registered with the UMIN Clinical Trials Registry (registration number: UMIN000030098; http://www.umin.ac.jp/ctr/index.htm).
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http://dx.doi.org/10.1093/jjco/hyy125DOI Listing
December 2018

Differences of tumor microenvironment between stage I lepidic-positive and lepidic-negative lung adenocarcinomas.

J Thorac Cardiovasc Surg 2018 10 4;156(4):1679-1688.e2. Epub 2018 Jun 4.

Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Chiba, Japan. Electronic address:

Objective: Lepidic growth is a noninvasive component of lung adenocarcinoma. Many adenocarcinoma cases contain coexistent lepidic and nonlepidic (invasive) components (lepidic-growth positive [Lep+] adenocarcinoma); however, some cases comprise only nonlepidic components (lepidic-growth negative [Lep-] adenocarcinoma). The aim of this study was to investigate the biological differences between the invasive components of Lep+ and Lep- adenocarcinoma.

Methods: We investigated the clinicopathologic characteristics of 232 adenocarcinomas (116 size-matched tumor pairs from Lep+ and Lep- adenocarcinomas). We then evaluated the cancer cell-specific expression levels of cancer stem cell, hypoxia, and invasion molecules in these lesions. The number of tumor-promoting stromal cells, including podoplanin-positive cancer-associated fibroblasts and CD204-positive tumor-associated macrophages, was also analyzed.

Results: Among cases with size-matched invasive components, significant differences were shown in total tumor size and predominant subtype in invasive component between Lep+ and Lep- adenocarcinomas. The expression levels of hypoxia-related molecules were significantly lower in Lep+ adenocarcinomas (glucose transporter 1: 0 vs 10, P < .01; carbonic anhydrase IX: 0 vs 0 [mean, 4.7 vs 14.1], P = .01). The number of podoplanin-positive cancer-associated fibroblasts and CD204-positive tumor-associated macrophages was significantly lower in Lep+ adenocarcinomas (podoplanin-positive cancer-associated fibroblasts: 0 vs 0 [mean: 1.6 vs 11.6], P < .01; CD204-positive tumor-associated macrophages: 8.7 vs 24.7, P < .01).

Conclusions: Our results indicated that lower cancer cell-specific expression levels of hypoxia markers and a smaller number of tumor-promoting stromal cells in invasive component were characteristic features of Lep+ adenocarcinomas.
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http://dx.doi.org/10.1016/j.jtcvs.2018.05.053DOI Listing
October 2018

Postoperative pulmonary complications and thoracocentesis associated with early versus late chest tube removal after thoracic esophagectomy with three-field dissection: a propensity score matching analysis.

Surg Today 2018 Nov 17;48(11):1020-1030. Epub 2018 Jul 17.

Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan.

Purpose: To evaluate the safety of early chest tube removal after thoracic esophagectomy with three-field dissection.

Methods: This prospective cohort study evaluated patients who underwent thoracic esophagectomy with three-field dissection during 2013-2015. Patients were divided into two groups according to whether they underwent early or late chest tube removal. Propensity score matching in a 1:1 ratio was applied. We compared the incidences of postoperative pulmonary complications and thoracocentesis in the two groups.

Results: After propensity score matching, 89 patients in each group were analyzed. There was no significant difference between the groups in the incidences of pulmonary complications or thoracocentesis. Significantly more patients achieved first mobilization within 15 h postoperatively in the early removal group (89.8%) than in the late removal group (52%, p < 0.01). Multivariate analysis revealed that early chest tube removal was not a risk factor for pulmonary complications or thoracocentesis. Independent risk factors for pulmonary complications were a history of pulmonary disease (odds ratio: 0.81 [0.63-0.98]; p = 0.02) and neoadjuvant chemotherapy (odds ratio: 0.67 [0.32-0.96]; p = 0.04).

Conclusion: Early chest tube removal is as safe and feasible as late chest tube removal after thoracic esophagectomy with three-field dissection.
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http://dx.doi.org/10.1007/s00595-018-1694-zDOI Listing
November 2018

Evaluation of liver function using gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging based on a three-dimensional volumetric analysis system.

Hepatol Int 2018 Jul 2;12(4):368-376. Epub 2018 Jun 2.

Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.

Background: Magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (EOB-MRI) is a diagnostic modality for liver tumors. Three-dimensional (3D) volumetric analysis systems using EOB-MRI data are used to simulate liver anatomy for surgery. This study was conducted to investigate clinical utility of a 3D volumetric analysis system on EOB-MRI to evaluate liver function.

Methods: Between August 2014 and December 2015, 181 patients underwent laboratory and radiological exams as standardized preoperative evaluation for liver surgery. The liver-spleen contrast-enhanced ratio (LSR) was measured by a semi-automated 3D volumetric analysis system on EOB-MRI. First, the inter-evaluator variability of the calculated LSR was evaluated. Additionally, a subset of liver surgical specimens was evaluated histologically by using immunohistochemical staining. Finally, the correlations between the LSR and grading systems of liver function, laboratory data, or histological findings were analyzed.

Results: The inter-evaluator correlation coefficient of the measured LSR was 0.986. The mean LSR was significantly correlated with the Child-Pugh score (p = 0.014) and the ALBI score (p < 0.001). Significant correlations were also observed between the LSR and indocyanine green retention rate at 15 min (r = - 0.601, p < 0.001), between the LSR and liver fibrosis stage (r = - 0.556, p < 0.001), and between the LSR and liver steatosis grade (r = - 0.396, p < 0.001).

Conclusion: The LSR calculated by a 3D volumetric analysis system on EOB-MRI was highly reproducible and was shown to be correlated with liver function parameters and liver histology. These data suggest that this imaging modality can be a reliable tool to evaluate liver function.
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http://dx.doi.org/10.1007/s12072-018-9874-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096956PMC
July 2018

Abdominal skin closure using subcuticular sutures prevents incisional surgical site infection in hepatopancreatobiliary surgery.

Surgery 2018 08 24;164(2):251-256. Epub 2018 May 24.

Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Japan.

Background: Hepatopancreatobiliary surgery has a high incidence of postoperative morbidity, including incisional surgical site infection. Although several studies showed that subcuticular sutures reduced incisional surgical site infection in other fields of surgery, their impact on hepatopancreatobiliary surgery remains unknown. The aim of this study was to assess whether subcuticular sutures could reduce incisional surgical site infection in patients undergoing hepatopancreatobiliary surgery.

Methods: A total of 436 consecutive patients underwent laparotomy and surgical resection for hepatopancreatobiliary tumors in our department from May 2013 to December 2015. We excluded among them, 8 patients with a follow-up period <30 days and 1 patient with unclear operative information. The incidence of incisional surgical site infection was compared between use of subcuticular sutures and of stapling, using propensity score analyses.

Results: In the baseline cohort (n = 427), abdominal skin closure was performed by subcuticular sutures in 245 patients (57.4%) and by stapling in 182 patients (42.6%). The incidence of incisional surgical site infection was 5/245 (2.0%) in the subcuticular suture group and 21/182 (11.5%) in the stapling group (P <. 01). In the propensity score-matched cohort (n = 318), patient demographics were well balanced between the two groups, and the incidence of incisional surgical site infection was 3/159 (1.8%) in the subcuticular suture group and 16/159 (10.0%) in the stapling group (P < .01). Propensity score analyses, as well as simple regression analyses, showed subcuticular sutures could consistently reduce incisional surgical site infection (with odd ratios of about 0.20).

Conclusion: Use of subcuticular sutures is preferred to stapling for the prevention of incisional surgical site infection in hepatopancreatobiliary surgery.
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http://dx.doi.org/10.1016/j.surg.2018.04.002DOI Listing
August 2018

Swallowing disorder following salvage total pharyngo-laryngo-esophagectomy with free jejunum reconstruction.

Oncol Lett 2018 May 8;15(5):7355-7361. Epub 2018 Mar 8.

Department of Head and Neck Surgery, National Cancer Research Center Hospital East, Kashiwa, Chiba 277-0882, Japan.

For recurrent cases or residual cases following concomitant chemo-radiation therapy (CCRT), salvage surgery is a frequently used treatment options. A swallowing disorder is one of the major complications of CCRT. The purpose of the present study was to evaluate the effect of CCRT on swallowing function in patients who underwent salvage total pharyngo-laryngo-esophagectomy (TPLE), and to evaluate the importance of pharyngeal constriction in patients who underwent TPLE. Between 2008 January and 2014 May, 54 patients were treated with salvage TPLE following CCRT or TPLE at the National Cancer Center Hospital East, Chiba, Japan and were included in the present study. A total of 14 patients underwent salvage TPLE following CCRT for recurrence or residual tumor (the salvage TPLE group), and 40 patients underwent TPLE as initial treatment (the TPLE group). The pharyngeal constriction score and the post-swallowing oropharyngeal residue rate were evaluated, and inadequate velopharyngeal closure was assessed by videofluorography. The pharyngeal constriction score of the salvage TPLE group was poorer than that of the TPLE group (P<0.05). The bolus residue in the oropharynx was significantly larger in the salvage TPLE group than in the TPLE group (P<0.05). With regards to inadequate velopharyngeal closure, there was no significant difference between the TPLE group and the salvage TPLE group (P>0.99). The results of the present study indicate that the swallowing function of patients who undergo salvage TPLE may be affected by CCRT.
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http://dx.doi.org/10.3892/ol.2018.8213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5920806PMC
May 2018